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Mental Health and Addiction Ad Hoc Agenda 03/19/2019Mental Health and Addiction Ad Hoc Committee Meeting March 19, 2019 – 8:30 am 5th Floor Training Room 3299 Tamiami Trail East, Bldg. F Naples, FL 34112 1. Call to Order 2. Pledge of Allegiance 3. Roll Call 4. Adoption of the Agenda 5. Public Comment 6. Adoption of Minutes from Previous Meeting 7. Staff Reports 7.1. Bruce McAndrews Resignation 8. New Business 8.1. Priority 2 – Permanent Supportive Housing 8.2. Collier County Vital Signs Report (Christine Welton) 8.3. Review of Calgary Housing Solutions (Dale Mullin) 8.4. Veteran Data for Collier County (Dale Mullin) 8.5. Committee Vacancies 9. Old Business 9.1. Future Meeting Schedule 9.2. Priority 1 – Centralized Receiving System (CRS) 9.3. Discussion of Bed Supply per capita 10. Announcements 11. Committee Member Discussion 12. Next Meeting Time, Date and Location 12.1. April 1, 2019 – 8:30 am – same location 13. Adjournment 30.A.2 Packet Pg. 733 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Mental Health and Addiction Ad Hoc Committee Meeting | Meeting Minutes Page 1 MINUTES OF THE REGULAR MEETING OF THE COLLIER COUNTY Mental Health and Addiction Ad Hoc Committee Meeting March 01, 2019 Naples, Florida LET IT BE REMEMBERED that the Collier County Mental Health and Addiction Ad Hoc Committee met on this date at 2:00 P.M. at 3299 Tamiami Trail East, Building F, 5th Floor Training Room, Naples, Florida with the following Members Present: Mental Health Committee Present: Dale Mullin Lt. Leslie Weidenhammer Dr. Thomas Lansen Scott Burgess The Honorable Janeice Martin Christine Welton Janice Rosen Pat Barton Dr. Jerry Godshaw Dr. Paul Simeone Council Member Michelle McLeod Dr. Pam Baker Reed Saunders Not Present: Bruce McAndrews Dr. Michael D’Amico Russell Budd Dr. Emily Ptaszek Susan Kimper Also Present: Sean Callahan – Executive Director, Corporate Business Ops Heather Cartwright-Yilmaz – Sr. Operations Analyst 30.A.2 Packet Pg. 734 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Mental Health and Addiction Ad Hoc Committee Meeting | Meeting Minutes Page 2 1. Call to Order & Pledge of Allegiance Chairman Scott Burgess called the meeting to order at 2:04 P.M. and led the Pledge of Allegiance. 3. Roll Call – Committee Members Thirteen (13) members of the Mental Health and Addiction Ad Hoc Committee were present, representing a quorum. Council Member McLeod introduced herself, followed by Committee members present, highlighting their backgrounds and different interests in serving on the Committee. 4. Adoption of the Agenda A motion to approve the agenda was made and was unanimously adopted. 5. Public Comment There was no public comment. 6. Adoption of Minutes from Previous Meeting Following discussion with two changes, a motion was made and Minutes from previous meeting were approved. 7. Staff Reports There were no staff reports. 8. New Business 8.1. Review of Prior Workshop Reports and Data Staff asked the committee if they were able to access the data that was provided in a drop box from previous workshops, committee members confirmed. Ms. Welton described a study done by Hodges University on vital statistics for Collier County that she will provide to staff for distribution to the committee. Dr. Lansen commented that he thought that the strategic plan in the SAMSHA document presented a holistic way to attack many of the priorities this committee is trying to address, and that he thought the metrics contained in the plan were excellent, asking if the committee was considering the same. Dr. Baker clarified that she provided the plan to ensure that this committee could align its priorities with the state strategic plan. Dr. Simeone then mentioned that he had an update on the universal release for data collection scheduled with attorneys, noting that one of the main difficulties of collecting this 30.A.2 Packet Pg. 735 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Mental Health and Addiction Ad Hoc Committee Meeting | Meeting Minutes Page 3 type of data is getting multiple agencies to agree to methods of collection and defining what data would be collected. Dr. Simeone commented that he would keep the committee apprised of any next steps for Lee Health. Mr. Burgess mentioned that data on homelessness existed through the Homeless Management Information System (HMIS) and thought that it might be helpful for Ms. Welton to talk about it at a future meeting. Discussion ensued around data collection from multiple agencies and the difficulty of managing due to multiple sources. Dr. Godshaw asked Judge Martin if there was data available from the problem-solving courts that the committee could analyze. Judge Martin said that the Department of Corrections would be the best place to find baseline data that would be most useful for statistical comparison. Mr. Burgess offered to check in with the South Florida Behavioral Healthcare System to see what reports they might be able to provide to the committee. Dr. Godshaw mentioned that he thought it would be pertinent to show a return on investment for different areas that the committee was looking at to effectively describe the resource needs. Dr. Baker mentioned that the committee could also look at statewide Baker Act reporting data to see the need in Florida and how Collier County compared. The committee then took a brief break before the 2:30 pm time certain item. 8.2. Skype Interaction with Manatee County Centerstone Staff – 2:30 Time Certain Ms. Melissa Larkin-Skinner introduced herself to Committee members, highlighting her background and different interests in serving the Community. Ms. Larkin-Skinner then gave some historical background on Manatee County and Centerstone as a designated CRS for the community. Some of the items that Ms. Larkin-Skinner discussed were: 1. Centralized Receiving System 2. Centerstone is multi-state corporation a. Manatee is only affiliate facility with Hospital and CSU 3. Impatient Hospital 4. Crisis Stabilization Unit 5. Psychiatric and Detox Facility 6. Partnerships: Takes ENTIRE Community to be Effective 7. Permanent Supportive Housing 8. Behavioral Health Data Collaborative 9. Increased Use of Evidence Based Practices 10. Increase Capacity of Problem-Solving Courts 11. Baker Act 30.A.2 Packet Pg. 736 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Mental Health and Addiction Ad Hoc Committee Meeting | Meeting Minutes Page 4 12. Marchman Act During the presentation, Committee members discussed the central receiving system, hospital, detox for drugs not just alcohol, funding and housing. One of the necessary items identified for success was having funding for current beds. The Centerstone facility has multi-discipline staff teams that ensures greater success rate as they can remove barriers for patients before they get out so that they do not return. Ms. Larkin-Skinner highlighted that the Centerstone facility serves everyone, including children and adults. Ms. Larkin-Skinner identified the following when asked by the committee on what metrics they track for their programs: • Turnaround to Law Enforcement • Return Rate • Follow-Up: If they come in for evaluation. Admitted as impatient. If they come back or in as outpatient; measure how long, it will be before they are admitted back to facility. • Interrupt the bouncing act, treat the illness, get client situated in normal outpatient program. Ms. Larkin-Skinner identified the following when asked by the committee lessons they have learned from the Manatee facility: • Every unit is designed with a bedroom and bathroom, which she would change • Communal restrooms around nurses station highly recommended • Select fixtures for safety: Patient Safety Priority One • Continuous Hinges: Do not have doors • Design spacing for future growth Ms. Larkin-Skinner identified the following when asked by the committee what gap areas exist in Manatee County: • Housing: Homelessness is number one reason patients return o Manatee area very expensive • Never enough of anything • Resources and Operations Funding Ms. Larkin-Skinner identified the following when asked by the committee about the different design sections of the facility: Geographic Areas: 3 Sections with Nurses Station • Adult Women • Adult Men • Children 30.A.2 Packet Pg. 737 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Mental Health and Addiction Ad Hoc Committee Meeting | Meeting Minutes Page 5 Hospital: • Division o Psychiatric o Addiction Ms. Larkin-Skinner identified the following when asked by the committee about the size of Manatee County vs. the number of facility beds: • Manatee County population: 380,000 • Centerstone facility includes o Psychiatric: 37 Beds o Crisis: 30 Beds • Beds are flexible: Not limited. The difference between units is billing Medicaid • Funding from local County for Detox for the that cannot pay – Must be local • Crisis Stabilization: Funded through state – Only pay for 30% of the cost. Ms. Larkin-Skinner said that she is willing to discuss further with the committee in the future. 8.3. Tampa Visit Briefing: Mr. Scott Burgess Mr. Burgess discussed trip to Tampa to visit the Gracepoint facilities in the area. Mr. Burgess mentioned that Manatee and Hillsboro are the same because they received their funding from Legislature. There were 5 of the initial awardees for CRS in the state, though another 4 were added since. There is a total of 9 in the state. The state was awarding 100% with a match from the County. They have now dropped it down to a 50% match. Committee discussion ensued around CSU application forms and if regulation would be easier for RSU. Mr. Burgess then informed the committee about the housing Mr. Mullin suggested that housing needs to be addressed as the number two priority. Discussion around Gracepoint was encouraging as permanent housing models were shared. One project was built with 90 units. Gracepoint is working on 2nd complex with 60 units as a model. Dr. Baker wanted to be on record recommending that varying people should be in the complex and not just those with mental illness and addiction. Mr. Burgess said the model Gracepoint is not only for mental illness, it is for affordability, financial criteria are used to make the placement decision. The first floor has office and retail space with residential units on the top floors. Committee discussion then ensued around Park Royal. Mr. Burgess said they had not looked at it at the David Lawrence Center for a hospitalization model. Dr. Godshaw said there are 7 treatment areas; however, wanted to confirm they have enough space. 30.A.2 Packet Pg. 738 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Mental Health and Addiction Ad Hoc Committee Meeting | Meeting Minutes Page 6 8.4 Priority 1 – Centralized Receiving System (CRS) Discussion CRS discussion above. 9. Old Business 9.1 Future Meeting Schedule • March 19th at 8:30 am • April 2nd at 8:30 am • April 16th at 8:30 am • April 30th at 8:30 am • May 14th at 8:30 am • May 28th at 8:30 am 9.2 February 25 Veterans Workshop Mr. Mullin discussed the Veterans Workshop that was held on February 25. 10. Announcements None 11. Committee Member Discussion Ms. McLeod recommended that the vacant seat be held for Adult care. Mr. Callahan asked if there were any future agenda items that the Committee might want to include during future meetings. Mr. Burgess recommended the CRS and moving onto the second priority of the committee which is housing. Mr. Callahan said he would get with Ms. Welton offline and will work with Dr. Baker for homeless initiative. 12. Next Meeting Time, Date and Location The next meeting is scheduled for March 19, 2019 at 8:30 A.M. in the Fifth Floor Training Room. 13. Adjournment The meeting was adjourned at 3:52 P.M. with nothing further to discuss. 30.A.2 Packet Pg. 739 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Mental Health and Addiction Ad Hoc Committee Meeting | Meeting Minutes Page 7 Collier County Mental Health and Addictions Ad Hoc Advisory Committee Scott Burgess – Chairman The foregoing Minutes were approved by Committee Chair on March 19, 2019, “as submitted” [ ] or “as amended” [ ] 30.A.2 Packet Pg. 740 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Mental Health and Addiction Ad Hoc Committee Meeting March 19, 2019 – 8:30 am Item 7.1 – Bruce McAndrews Resignation From: Mac <bmchammer@comcast.net> Sent: Tuesday, March 5, 2019 4:18 PM To: Scott Burgess <scottb@dlcmhc.com> Subject: ad hoc committee Good afternoon Scott, Hopefully you had received my voicemail last Friday. I had alluded to some medical issues that need to be addressed sooner rather than later (per the Drs. Assessments) and what started out as a hip replacement has evolved into back surgery first and then the hip. Given this information I believe it is only fair that I resign as a member of the above committee. I have not been able to attend the first two meetings and given my unknown future scheduling I feel that I will not be able to fulfill my commitment properly. Perhaps someone else who made application can be considered as an alternate. Although I am powerless over these circumstances I would ask that you as Chairperson extend my apologies to the entire committee for my absenteeism past and future. It was an honor and a privilege to even be considered for an appointment to this illustrious committee. I was looking forward to working with the other members in addressing the mental health and substance abuse issues that our community has been and will be facing and I thank you for your continued diligence in leading Collier County and Southwest Florida towards the goal of viable solutions. Despite my soon to be limited capacity if I can help or volunteer time in any area please do not hesitate to call . I thank you in advance for your deliverance of this message and I wish you and the committee the very best in all your endeavors. Sincerely, Bruce McAndrews Sent from Mail for Windows 10 30.A.2 Packet Pg. 741 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Mental Health and Addiction Ad Hoc Committee Meeting March 19, 2019 – 8:30 am Item 8.2 – Collier County Vital Statistics Report Hello Sean, Hope your having a great week. At the last meeting I mentioned before I had to leave that Hodges had put out a 2018 Vital Signs Report for Collier County and the group may find some of the stats helpful for the group. I have attached it so that you can send it out if you wish. Thanks, Christine Welton Executive Director Hunger & Homeless Coalition of Collier County ExecutiveDirector@collierhomelesscoalition.org P.O. Box 9202 Naples , FL 34101-9202 (239) 263-9363 (Phone) (239) 2101379 (Cell) (239) 263-6058 (Fax) Visit us on the web at www.collierhomelesscoalition.org 30.A.2 Packet Pg. 742 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Johnson School of Business 2018 Vital Signs Report October 11, 2018 30.A.2 Packet Pg. 743 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 2 of 115 All rights reserved, including the right of reproduction in whole or in part in any form, by Community Foundation of Collier County. 30.A.2 Packet Pg. 744 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 3 of 115 This report was compiled by the Johnson School of Business Hodges University, Naples, FL Contact Information Aysegul Timur, Ph.D., atimur@hodges.edu Anke Stugk, Ph.D., astugk@hodges.edu Eve Olvera, BS, eolvera@hodges.edu 30.A.2 Packet Pg. 745 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 4 of 115 About Hodges University Founded in 1990, Hodges University is a private nonprofit organization and one of Florida’s leading institutions of higher learning. With campuses located in Naples and Fort Myers, the university prepares students to leverage higher learning in their personal, professional and civic endeavors. In addition to offering associate, baccalaureate, and graduate degrees in a variety of disciplines and delivery options, Hodges University enhances the ability of students to achieve personal and professional objectives through diverse educational experiences and programs including English as a Second Language and the Center for Lifelong Learning. For more information, call (239) 513-1122 or visit Hodges.edu. 30.A.2 Packet Pg. 746 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 5 of 115 Contents Collier County Demographics .................................................................................................................... 12 TABLE 1 Total Population Estimates ................................................................................................ 12 TABLE 2 Forecast Estimates of Total Population ............................................................................. 12 GRAPH 1 Collier County–Forecast Estimates of Total Population ................................................... 12 TABLE 3 Total Population Estimates Percentage Change ................................................................. 13 GRAPH 2 Collier County–Total Population Estimates Percentage Change ...................................... 13 TABLE 4 Population Estimates Gender Distribution ......................................................................... 14 GRAPH 3 Collier County–Population Estimates Gender Distribution .............................................. 14 Population by Age Groups ...................................................................................................................... 15 TABLE 5 Collier County–Population by Age Group in Percent ....................................................... 15 TABLE 6 Florida–Population by Age Group in Percent .................................................................... 16 TABLE 7 United States–Population by Age Group in Percent .......................................................... 17 GRAPH 4 Collier County–Age Groups as Percentage of Total Population ...................................... 18 TABLE 8 Collier County–Age Groups as Percentage of Total Population (Forecast by 2050) ........ 19 GRAPH 5 Collier County–Total Population by Age Group Forecast by 2050 .................................. 19 TABLE 9 Population Estimates Under 18 Years ............................................................................... 20 TABLE 10 Population Estimates 65 and Over ................................................................................... 20 GRAPH 6 Collier County Population Trend Line .............................................................................. 21 TABLE 11 Components of Resident Population Change: April 1, 2010 to July 1, 2017 .................. 21 Population by Race or Ethnicity.............................................................................................................. 22 TABLE 12 Ethnicity–Hispanic or Latino ........................................................................................... 22 GRAPH 7 2017 Collier County Hispanic/Latino Population ............................................................. 22 GRAPH 8 2050 Collier County Hispanic/Latino Population (Forecast Estimation) ......................... 23 TABLE 13 Race Alone or in Combination with One or More Other Races ...................................... 24 GRAPH 9 2017 Collier County Population by Race.......................................................................... 25 Economic Indicator ..................................................................................................................................... 25 Economic Wealth Index .......................................................................................................................... 25 TABLE 14 Woods & Poole Economic Wealth Index ........................................................................ 25 GRAPH 10 Economic Wealth Index .................................................................................................. 26 Gross Regional Product ........................................................................................................................... 26 30.A.2 Packet Pg. 747 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 6 of 115 TABLE 15 Gross Regional Product (in millions of 2009 dollars) ..................................................... 26 Unemployment ........................................................................................................................................ 26 TABLE 16 Annual Unemployment Rate–Not Seasonally Adjusted .................................................. 26 GRAPH 11 2017-2018 Monthly Unemployment Rate–Not Seasonally Adjusted ............................. 27 Employment and Economic Opportunity ................................................................................................... 28 TABLE 17 Labor Force and Employment Status ............................................................................... 28 GRAPH 12 Labor Force ..................................................................................................................... 29 TABLE 18 Females 16 Years and Over Labor Force ......................................................................... 30 GRAPH 13 Female Labor Force ........................................................................................................ 30 TABLE 19 Employment Status with Own Child ............................................................................... 31 TABLE 20 Occupations ...................................................................................................................... 32 GRAPH 14 2017 Collier County Occupations ................................................................................... 33 TABLE 21 Fastest-Growing Industries in Collier County ................................................................. 34 TABLE 22 Industries Gaining the Most New Jobs in Collier County ............................................... 35 TABLE 23 Fastest-Growing Occupations in Collier County ............................................................. 36 TABLE 24 Occupations Gaining the Most New Jobs in Collier County ........................................... 37 TABLE 25 Declining or Slow-Growth Occupations in Collier County ............................................. 38 Compensation .......................................................................................................................................... 39 TABLE 26 Average Annual Pay ........................................................................................................ 39 GRAPH 15 Average Annual Pay ....................................................................................................... 39 TABLE 27 Average Weekly Pay ........................................................................................................ 40 GRAPH 16 Average Weekly Pay ....................................................................................................... 40 TABLE 28 Collier County Subdivisions–Median Income ................................................................. 41 Housing ....................................................................................................................................................... 41 Poverty and Homelessness ...................................................................................................................... 41 TABLE 29 Point-in-Time Estimates of Homeless People ................................................................. 41 TABLE 30 Highest Rates of Unsheltered Homeless People by State in 2017 ................................... 42 TABLE 31 Highest Rates of Unsheltered Homeless People in Families by State in 2017 ................ 42 TABLE 32 Collier County Homeless Students Reported in Florida Public Schools by Florida County ................................................................................................................................................. 42 TABLE 33 Causes of Homelessness in Florida .................................................................................. 43 30.A.2 Packet Pg. 748 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 7 of 115 GRAPH 17 2016 Causes of Homelessness in Florida ........................................................................ 43 TABLE 34 Total Percentage of Poverty by Age Group ..................................................................... 44 TABLE 35 Below Poverty Level by Employment Status .................................................................. 45 Housing Cost and Foreclosure ................................................................................................................ 45 TABLE 36 Housing Cost Burden ....................................................................................................... 45 GRAPH 18 Collier County Housing Cost Burden as Percentage of Household Income–Population 65+ ....................................................................................................................................................... 46 TABLE 37 Foreclosure Status Distribution–August 2018 ................................................................. 46 TABLE 38 Median Home Prices–August 2018 ................................................................................. 47 Environment ................................................................................................................................................ 47 Protected Land and Conservations .......................................................................................................... 47 TABLE 39 Protected Land Almanac .................................................................................................. 47 GRAPH 19 Collier County Map of Protected Land ........................................................................... 48 TABLE 40 Conservation Land by Lead Managing Agency in Acres ................................................ 48 Healthcare ................................................................................................................................................... 49 TABLE 41 Registered Nonprofit Organizations in Health and Mental Health .................................. 49 County Health Ranking ........................................................................................................................... 49 GRAPH 20 Collier County Overall Health Outcomes and Health Factors Ranking Among 67 Florida Counties .................................................................................................................................. 49 GRAPH 21 Collier County Health Outcomes Components Ranking Among 67 Florida Counties .. 50 GRAPH 22 Collier County Health Factors Components Ranking Among 67 Florida Counties ....... 51 Reported Health Issues ............................................................................................................................ 51 TABLE 42 Population Reporting Poor or Fair Health in Percent ...................................................... 51 GRAPH 23 Reported Poor or Fair Health .......................................................................................... 52 TABLE 43 Reported Poor Physical and Mental Health Days per Month .......................................... 52 GRAPH 24 Reported Poor Physical Health Days .............................................................................. 53 GRAPH 25 Reported Poor Mental Health Days ................................................................................ 53 TABLE 44 Adult Obesity–Percent of Population .............................................................................. 54 TABLE 45 Low Birth Weight as Percentage of Total Births ............................................................. 54 TABLE 46 Reported Excessive Alcohol Consumption (percent of total population) ........................ 54 TABLE 47 Teen Birth Rate as Percentage ......................................................................................... 55 30.A.2 Packet Pg. 749 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 8 of 115 GRAPH 26 Teen Birth Rate as Percentage ........................................................................................ 55 TABLE 48 Population Reporting Inadequate Social Support in Percent of Total Population ........... 55 TABLE 49 Primary Care Physicians .................................................................................................. 56 TABLE 50 Mental Healthcare Providers ............................................................................................ 56 GRAPH 27 Collier County Primary Care Physicians and Mental Healthcare Providers ................... 57 Health Insurance ...................................................................................................................................... 58 TABLE 51 Collier County–Percent No Health Insurance by Sex and Age ....................................... 58 TABLE 52 Florida–Percent No Health Insurance by Sex and Age.................................................... 59 TABLE 53 United States–Percent No Health Insurance by Sex and Age .......................................... 60 GRAPH 28 Adults Could Not See a Doctor Due to Cost ................................................................... 61 TABLE 54 Total U.S. Current Health Expenditure as Percent of Gross Domestic Product .............. 61 GRAPH 29 Total U.S. Current Health Expenditure as Percent of Gross Domestic Product ............. 62 TABLE 55 2018A Household and Healthcare Demographics and 2023 Demographic Household and Healthcare Estimates–Collier County ................................................................................................. 63 TABLE 56 2018A Household and Healthcare Demographics and 2023 Demographic Household and Healthcare Estimates–Florida .............................................................................................................. 64 TABLE 57 2018A Household and Healthcare Demographics and 2023 Demographic Household and Healthcare Estimates–United States .................................................................................................... 65 TABLE 58 Healthcare Insurance 2018A Statistics and 2023 Estimates ............................................ 66 TABLE 59 Healthcare Services and Other Services 2018A Statistics and 2023 Estimates ............... 67 TABLE 60 Healthcare Supplies and Equipment 2018A Statistics and 2023 Estimates..................... 68 GRAPH 30 Selected Vaccine-Preventable Disease Rate for All Ages .............................................. 69 GRAPH 31 Preventable Hospitalizations under 65 from Vaccine-Preventable Conditions .............. 70 TABLE 61 HIV/AIDS Rate per 100,000 ............................................................................................ 71 GRAPH 32 HIV/AIDS Age Adjusted Death Rate ............................................................................. 71 TABLE 62 Total Gonorrhea, Chlamydia & Infectious Syphilis Rate per 100,000 ............................ 72 GRAPH 33 Total Gonorrhea, Chlamydia & Infectious Syphilis Rate ............................................... 72 TABLE 63 Total Number of ER Visits in which the Patient was Uninsured/Underinsured in Collier County ................................................................................................................................................. 72 Middle and High School Student Risk Factors ........................................................................................... 73 TABLE 64 Percent of Collier County Elementary and Middle School Students at Risk for Being Overweight .......................................................................................................................................... 73 30.A.2 Packet Pg. 750 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 9 of 115 TABLE 65 Percent of Collier County Elementary and Middle School Students in the Obese Range ............................................................................................................................................................. 73 GRAPH 34 Collier County Elementary and Middle School Student Weight Risk ............................ 73 TABLE 66 Percentage of Collier County and Florida Statewide Youth in Middle School and High School Who Reported Gang Membership–2008 to 2018 .................................................................... 74 TABLE 67 Percentage of Surveyed Collier County and Florida Youth Who Reported Alcohol Use in the Past 30 Days .............................................................................................................................. 74 TABLE 68 Percentages of Collier County and Florida Youth Who Reported They Skipped School Because of Bullying............................................................................................................................. 75 Adults with Health-Related Difficulties .................................................................................................. 76 TABLE 69 Percent of Residents with Ambulatory Difficulty ............................................................ 76 TABLE 70 Percent of Residents with Self-Care Difficulty ................................................................ 77 TABLE 71 Percent of Residents with Independent Living Difficulty ............................................... 78 Education .................................................................................................................................................... 79 TABLE 72 School District of Collier County Demographics - All Grades ....................................... 79 GRAPH 35 2018 School District of Collier County Demographics .................................................. 80 TABLE 73 Free and Reduced Lunch by Grade Level ........................................................................ 80 GRAPH 36 Free and Reduced Lunch ................................................................................................. 81 TABLE 74 Limited English Proficiency (LEP)-School District of Collier County ........................... 82 TABLE 75 Language Spoken at Home (2017 Estimate).................................................................... 83 TABLE 76 ACT Test Takers and Participation Rate (Public Schools) .............................................. 83 TABLE 77 ACT Average Scores (Public Schools) ............................................................................ 84 TABLE 78 Collier County ACT Composite Scores and Participation by Race (Public Schools) ..... 84 TABLE 79 FSA English Language Arts Scores - Percent of Students Scoring Three or Above (Public Schools) ................................................................................................................................... 85 TABLE 80 SAT Five-Year Trend of Participation Rates (Public Schools) ....................................... 85 TABLE 81 SAT Critical Reading, Writing and Math Mean Score Comparison ............................... 86 TABLE 82 Collier County Five-Year Trend for College-Bound Senior SAT Test Takers: Mean Scores and Participation Rate by Ethnicity ......................................................................................... 86 TABLE 83 Mean SAT Scores Public and Independent School Comparison ..................................... 87 TABLE 84 High School Graduation Rates, Florida's Calculation ..................................................... 88 GRAPH 37 High School Graduation Rate ......................................................................................... 88 30.A.2 Packet Pg. 751 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 10 of 115 TABLE 85 School Enrollment............................................................................................................ 89 TABLE 86 Educational Attainment.................................................................................................... 90 TABLE 87 Collier County Detailed Field of Bachelor’s Degree for First Major for the Population 25 Tears and Over ..................................................................................................................................... 91 TABLE 88 Florida Detailed Field of Bachelor’s Degree for First Major for the Population 25 Years and Over .............................................................................................................................................. 92 TABLE 89 United States Detailed Field of Bachelor’s Degree for First Major for the Population 25 Years and Over .................................................................................................................................... 93 Recreation, Arts, and Leisure...................................................................................................................... 94 TABLE 90 Employment in Arts, Entertainment, and Recreation (in thousands of jobs) .................. 94 GRAPH 38 Employment in Arts, Entertainment, and Recreation ..................................................... 94 TABLE 91 Earnings in Arts, Entertainment, & Recreations (in millions of 2009 dollars) ................ 95 Nonprofits in Arts, Entertainment, & Recreation ................................................................................... 95 TABLE 92 Registered Nonprofit Organizations ................................................................................ 95 TABLE 93 Percentage of Students (PK-12) Who Participated in a Fine Arts Discipline .................. 96 TABLE 94 Number of Fine Arts Classes by Discipline (PK-12) ....................................................... 96 Charitable Giving ........................................................................................................................................ 97 TABLE 95 Average Charitable Giving and Adjusted Gross Income (Household Income by Zip) ... 97 GRAPH 39 Itemized Tax Return Reporting Contributions ................................................................ 98 TABLE 96 Florida–Average Charitable Giving and Adjusted Gross Income by Income Level ....... 98 TABLE 97 United States–Average Charitable Giving and Adjusted Gross Income by Income Level ............................................................................................................................................................. 99 Volunteering ............................................................................................................................................... 99 TABLE 98 Volunteer Rates and Hours by Age Group ...................................................................... 99 TABLE 99 Volunteer Rates and Hours by Race .............................................................................. 100 GRAPH 40 Volunteer Rate .............................................................................................................. 100 GRAPH 41 Volunteer Interest Areas ............................................................................................... 101 GRAPH 42 Top 5 Volunteer Activities ............................................................................................ 101 Collier County 211 Caller Statistics ......................................................................................................... 102 TABLE 100 Collier County 2-1-1 Total Calls per Month by Fiscal Year ....................................... 102 TABLE 101 Collier County 2-1-1 Call Problems/Needs for July 2017-June 2018 ......................... 103 TABLE 102 Collier County 2-1-1 Total Calls per Month per Gender for May 2018–August 2018103 30.A.2 Packet Pg. 752 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 11 of 115 TABLE 103 Collier County 2-1-1 Total Calls per Month per Gender for May–August 2018 ........ 104 Children and Child Care ........................................................................................................................... 104 TABLE 104 Private Child Day Care Services by Population Under 5 years ................................... 104 GRAPH 43 Children per Day Care Ratio ......................................................................................... 105 GRAPH 44 Change in Population Under 5 Years and Change in Child Day Care.......................... 106 TABLE 105 Householder with Own Children Under 18 and No Spouse Present ........................... 107 TABLE 106 Percentage of All Married-Couples and Single Parents with Own Children Under 18 ........................................................................................................................................................... 108 TABLE 107 Grandchildren Under 18 Years Living with Grandparents .......................................... 109 Children in Poverty ............................................................................................................................... 110 GRAPH 45 Percentage of Related Children Under 5 Years Living Below Poverty Level .............. 110 GRAPH 46 Percentage of Related Children 5-17 Years Living Below Poverty Level ................... 111 TABLE 108 Percentage of Families and People Whose Income in the Past 12 Months is Below Poverty Level ..................................................................................................................................... 112 TABLE 109 Percentage of Households Receiving Food Stamps/SNAP with Children Under 18 .. 113 Domestic Violence .................................................................................................................................... 113 TABLE 110 Reported Domestic Violence Offenses for 2013-2017 ................................................ 113 TABLE 111 Collier County and Florida Reported Domestic Violence Offenses Rate per 100,000 Population from 2013 to 2017 ........................................................................................................... 114 GRAPH 47 Domestic Violence Offense Rate .................................................................................. 114 TABLE 112 National Human Trafficking Resource Center Inbound Phone Call Statistics ............ 115 30.A.2 Packet Pg. 753 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 12 of 115 Collier County Demographics In 2017, Collier County had a reported total population of 372,880. This represented a percentage increase of 2.12 from the prior year. Total population in Florida and the United States also increased from year to year since 2012, but at a lower rate compared to Collier County. The percentage change from 2016 to 2017 was 1.80 in Florida and 0.80 in the United States. TABLE 1 Total Population Estimates 2012 2013 2014 2015 2016 2017 Collier County 332,332 339,244 347,899 356,570 365,136 372,880 Florida 19,344,156 19,582,022 19,888,741 20,244,914 20,612,439 20,984,400 United States 313,998,379 316,204,908 318,563,456 320,896,618 323,127,513 325,719,178 Source: U.S. Census Bureau. (2018). 2017 Population Estimates: Table PEPAGESEX. Retrieved from http://factfinder.census.gov It is estimated that the total population for Collier County, the State of Florida, and the United States will continue to increase in 2020. TABLE 2 Forecast Estimates of Total Population 2020* 2040* 2050* Collier County 397,917 600,778 722,109 Florida 21,857,940 28,901,330 32,585,100 United States 335,057,800 397,911,600 426,439,400 Source: Woods & Poole. (2018). 2018 State Profile: Florida [DATA FILE]. Washington, DC: Author (*Forecast Estimation) GRAPH 1 Collier County–Forecast Estimates of Total Population Source: Woods & Poole. (2018). 2018 State Profile: Florida [DATA FILE]. Washington, DC: Author (*Forecast Estimation) 2020, 397,917 2040, 600,778 2050, 722,109 0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 Collier County-Forecast Estimates of Total Population 30.A.2 Packet Pg. 754 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 13 of 115 TABLE 3 Total Population Estimates Percentage Change from 2012 to 2013 from 2013 to 2014 from 2014 to 2015 from 2015 to 2016 from 2016 to 2017 Collier County 2.08% 2.55% 2.49% 2.40% 2.12% Florida 1.23% 1.57% 1.79% 1.82% 1.80% United States 0.70% 0.75% 0.73% 0.70% 0.80% Source: U.S. Census Bureau. (2018). 2017 Population Estimates: Table PEPAGESEX. Retrieved from http://factfinder.census.gov GRAPH 2 Collier County–Total Population Estimates Percentage Change Source: U.S. Census Bureau. (2018). 2017 Population Estimates: Table PEPAGESEX. Retrieved from http://factfinder.census.gov 0.00% 0.50% 1.00% 1.50% 2.00% 2.50% 3.00% from 2012 to 2013 from 2013 to 2014 from 2014 to 2015 from 2015 to 2016 from 2016 to 2017 Collier County-Total Population Estimates Percentage Change 30.A.2 Packet Pg. 755 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 14 of 115 Population estimates indicate that Collier County, the State of Florida, and the United States have a higher female gender distribution versus the male gender distribution. On average, the gender population is 51.00 percent female and 49.00 percent male. TABLE 4 Population Estimates Gender Distribution 2012 2013 2014 2015 2016 2017 Collier County Male 49.12% 49.15% 49.18% 49.19% 49.06% 49.21% Female 50.88% 50.85% 50.82% 50.81% 50.94% 50.79% Florida Male 48.88% 48.88% 48.88% 48.87% 48.85% 48.88% Female 51.12% 51.12% 51.12% 51.13% 51.15% 51.12% United States Male 49.19% 49.21% 49.21% 49.22% 49.23% 49.25% Female 50.81% 50.79% 50.79% 50.78% 50.77% 50.75% Source: U.S. Census Bureau. (2018). 2017 Population Estimates: Table PEPAGESEX. Retrieved from http://factfinder.census.gov GRAPH 3 Collier County–Population Estimates Gender Distribution Source: U.S. Census Bureau. (2018). 2017 Population Estimates: Table PEPAGESEX. Retrieved from http://factfinder.census.gov 48.00% 48.50% 49.00% 49.50% 50.00% 50.50% 51.00% 51.50% 2012 2013 2014 2015 2016 2017 Collier County-Population Estimates Gender Distribution Male Female 30.A.2 Packet Pg. 756 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 15 of 115 Population by Age Groups Collier County has seen an increase of total population since 2013. The largest age group in Collier County is between 65 and 74 years of age. In 2017, this age group represented 16.00 percent of the total population in Collier County, 11.20 percent of the total population in Florida, and 9.10 percent of the national total population. TABLE 5 Collier County–Population by Age Group in Percent 2013 2014 2015 2016 2017 Collier County Total Population 339,642 348,777 357,305 365,136 372,880 Under 5 years 4.80% 4.80% 4.60% 4.50% 4.50% 5 to 9 years 4.70% 4.90% 4.90% 5.20% 4.80% 10 to 14 years 6.10% 5.40% 5.20% 4.80% 5.10% 15 to 19 years 4.90% 5.40% 5.10% 5.20% 4.50% 20 to 24 years 5.20% 5.00% 5.00% 4.70% 5.00% 25 to 34 years 10.10% 9.70% 9.80% 9.60% 9.70% 35 to 44 years 10.30% 10.20% 9.80% 10.00% 9.70% 45 to 54 years 12.20% 12.20% 12.10% 11.50% 11.80% 55 to 59 years 6.40% 6.00% 6.70% 6.10% 6.90% 60 to 64 years 6.80% 7.10% 6.60% 7.30% 6.50% 65 to 74 years 15.00% 15.30% 15.60% 16.30% 16.00% 75 to 84 years 10.10% 10.80% 11.00% 10.40% 11.20% 85 years and over 3.40% 3.20% 3.50% 4.20% 4.30% Source: U.S. Census Bureau. (2018). 2017 American Community Survey 1-year estimates: Table CP05. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 757 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 16 of 115 TABLE 6 Florida–Population by Age Group in Percent 2013 2014 2015 2016 2017 Florida Total Population 19,552,860 19,893,297 20,271,272 20,612,439 20,984,400 Under 5 years 5.50% 5.40% 5.40% 5.40% 5.40% 5 to 9 years 5.60% 5.60% 5.60% 5.50% 5.40% 10 to 14 years 5.90% 5.80% 5.70% 5.70% 5.70% 15 to 19 years 6.10% 6.00% 6.00% 5.90% 5.90% 20 to 24 years 6.70% 6.60% 6.30% 6.10% 6.00% 25 to 34 years 12.50% 12.60% 12.80% 12.90% 12.90% 35 to 44 years 12.30% 12.20% 12.20% 12.00% 12.10% 45 to 54 years 13.90% 13.70% 13.50% 13.40% 13.20% 55 to 59 years 6.80% 6.70% 6.70% 6.90% 6.90% 60 to 64 years 6.10% 6.20% 6.40% 6.40% 6.40% 65 to 74 years 10.20% 10.50% 10.80% 11.10% 11.20% 75 to 84 years 5.90% 5.90% 6.10% 6.20% 6.30% 85 years and over 2.50% 2.60% 2.60% 2.60% 2.60% Source: U.S. Census Bureau. (2018). 2017 American Community Survey 1-year estimates: Table CP05. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 758 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 17 of 115 TABLE 7 United States–Population by Age Group in Percent 2013 2014 2015 2016 2017 United States Total Population 316,128,839 318,857,056 321,418,821 323,127,515 325,719,178 Under 5 years 6.30% 6.20% 6.20% 6.10% 6.10% 5 to 9 years 6.50% 6.40% 6.40% 6.30% 6.20% 10 to 14 years 6.60% 6.50% 6.40% 6.40% 6.50% 15 to 19 years 6.80% 6.70% 6.70% 6.70% 6.60% 20 to 24 years 7.20% 7.10% 7.00% 6.90% 6.70% 25 to 34 years 13.50% 13.60% 13.70% 13.70% 13.80% 35 to 44 years 12.80% 12.80% 12.70% 12.60% 12.60% 45 to 54 years 13.80% 13.60% 13.40% 13.20% 13.00% 55 to 59 years 6.70% 6.70% 6.70% 6.70% 6.70% 60 to 64 years 5.80% 5.90% 6.00% 6.10% 6.20% 65 to 74 years 8.00% 8.30% 8.60% 8.90% 9.10% 75 to 84 years 4.30% 4.30% 4.40% 4.40% 4.60% 85 years and over 1.90% 1.90% 1.90% 1.90% 1.90% Source: U.S. Census Bureau. (2018). 2017 American Community Survey 1-year estimates: Table CP05. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 759 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 18 of 115 GRAPH 4 Collier County–Age Groups as Percentage of Total Population Source: U.S. Census Bureau. (2018). 2017 American Community Survey 1-year estimates: Table CP05. Retrieved from http://factfinder.census.gov 20.40%19.90%19.60%19.60%19.40% 25.40%25.30%25.40%24.90%25.20% 25.10%26.10%26.60%26.70%27.20% 3.40%3.20%3.50%4.20%4.30% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00% 2013 2014 2015 2016 2017 Collier County-Age Groups as Percentage of Total Population 85 years and over 65 to 84 years 45 to 64 years 25 to 44 years 20 to 24 years 15 to 19 years 5 to 14 years Under 5 years 30.A.2 Packet Pg. 760 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 19 of 115 In 2017, the percentage of population 65 to 69 years was the highest age group in Collier County; however, it is forecast to decline in 2050. TABLE 8 Collier County–Age Groups as Percentage of Total Population (Forecast by 2050) 2017 2018 2019* 2020* 2025* 2030* 2035* 2040* 2045* 2050* Collier County 20 to 24 years 4.80% 4.79% 4.73% 4.75% 4.72% 4.56% 4.16% 4.15% 4.21% 4.20% 25 to 29 years 4.89% 5.03% 5.20% 5.27% 5.29% 5.26% 5.01% 4.53% 4.52% 4.58% 30 to 34 years 4.84% 4.78% 4.79% 4.79% 5.30% 5.38% 5.32% 5.07% 4.59% 4.62% 35 to 39 years 4.80% 4.78% 4.75% 4.69% 4.69% 5.18% 5.27% 5.22% 5.00% 4.57% 40 to 44 years 4.80% 4.71% 4.63% 4.61% 4.49% 4.49% 4.93% 5.03% 5.01% 4.85% 45 to 49 years 5.59% 5.42% 5.24% 5.02% 4.42% 4.29% 4.26% 4.69% 4.80% 4.84% 50 to 54 years 6.16% 6.02% 5.83% 5.68% 4.98% 4.36% 4.21% 4.18% 4.60% 4.78% 55 to 59 years 6.57% 6.61% 6.64% 6.67% 5.98% 5.20% 4.49% 4.33% 4.30% 4.76% 60 to 64 years 6.87% 6.92% 6.99% 7.04% 7.16% 6.32% 5.41% 4.66% 4.49% 4.47% 65 to 69 years 7.89% 7.76% 7.73% 7.77% 8.02% 8.07% 7.06% 6.03% 5.20% 5.07% Source: Woods & Poole. (2018). 2018 State Profile: Florida [DATA FILE]. Washington, DC: Author (*Forecast Estimation) GRAPH 5 Collier County–Total Population by Age Group Forecast by 2050 Source: Woods & Poole. (2018). 2018 State Profile: Florida [DATA FILE]. Washington, DC: Author (*Forecast Estimation) 30.A.2 Packet Pg. 761 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 20 of 115 From 2013-2017, the percentage of population under 18 years old has been declining at the county, state, and national level. Over the same period of time, the percentage of population 65 years and over has been increasing at the county, state, and national level. Compared to state and national levels, in 2017 Collier County had the lowest percentage of population under 18 years; however, came in second for the highest percentage of population 65 years and over. TABLE 9 Population Estimates Under 18 Years 2013 2014 2015 2016 2017 Collier County 62,793 63,544 63,998 64,262 64,749 % of Total Population 18.51% 18.27% 17.95% 17.60% 17.36% Florida 4,023,512 4,054,764 4,100,495 4,146,712 4,201,983 % of Total Population 20.55% 20.39% 20.25% 20.12% 20.02% United States 73,579,424 73,577,154 73,616,759 73,642,285 73,655,378 % of Total Population 23.27% 23.10% 22.94% 22.79% 22.61% Source: U.S. Census Bureau. (2018). 2017 Population Estimates: Table PEPAGESEX. Retrieved from http://factfinder.census.gov TABLE 10 Population Estimates 65 and Over 2013 2014 2015 2016 2017 Collier County 98,007 102,591 107,721 113,064 117,384 % of Total Population 28.89% 29.49% 30.21% 30.96% 31.48% Florida 3,648,852 3,792,505 3,941,129 4,094,917 7,214,635 % of Total Population 18.63% 19.07% 19.47% 19.87% 34.38% United States 44,670,144 46,211,686 47,734,292 49,244,195 50,858,679 % of Total Population 14.13% 14.51% 14.88% 15.24% 15.61% Source: U.S. Census Bureau. (2018). 2017 Population Estimates: Table PEPAGESEX. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 762 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 21 of 115 The comparison of population groups in Collier County indicates that the population under 18 years is declining, while the age group of 65 and over is increasing. GRAPH 6 Collier County Population Trend Line Source: U.S. Census Bureau. (2018). 2017 Population Estimates: Table PEPAGESEX. Retrieved from http://factfinder.census.gov From 2010 to 2017, Collier County had a total population change of 51,360. Most of Collier County’s population change is due to domestic migration. TABLE 11 Components of Resident Population Change: April 1, 2010 to July 1, 2017 Source: U.S. Census Bureau. (2018). 2017 Population Estimates: Table PEPTCOMP. Retrieved from http://factfinder.census.gov 15.00% 17.00% 19.00% 21.00% 23.00% 25.00% 27.00% 29.00% 31.00% 33.00% 2013 2014 2015 2016 2017Percent of total PopulationCollier County Population Estimation % of Total Population under 18 years % of Total Population 65 years and over Total Population Change Natural Increase Births Deaths Net Migration Total Net Migration International Net Migration Domestic Collier County 51,360 978 23,497 22,522 50,154 16,518 33,636 Florida 2,179,806 235,054 1,582,037 1,346,983 1,936,102 910,841 1,025,261 United States 16,961,073 9,727,447 28,703,158 18,975,711 7,233,626 7,233,626 (X) 30.A.2 Packet Pg. 763 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 22 of 115 Population by Race or Ethnicity In 2017, Collier County consisted of 27.80 percent Hispanic or Latino population and 72.20 percent non- Hispanic population. In Florida, Hispanic or Latino population represented 25.60 percent of the total population, and in the U.S. Hispanics or Latinos represented 18.10 percent of the total population. TABLE 12 Ethnicity–Hispanic or Latino 2013 2014 2015 2016 2017 Collier County Total Population 339,642 348,777 357,305 365,136 372,880 Hispanic or Latino 26.30% 26.70% 26.80% 27.00% 27.80% Not Hispanic or Latino 73.70% 73.30% 73.20% 73.00% 72.20% Florida Total Population 19,552,860 19,893,297 20,271,272 20,612,439 20,984,400 Hispanic or Latino 23.60% 24.10% 24.50% 24.90% 25.60% Not Hispanic or Latino 76.40% 75.90% 75.50% 75.10% 74.40% U.S. Total population 316,128,839 318,857,056 321,418,821 323,127,515 325,719,178 Hispanic or Latino 17.10% 17.30% 17.60% 17.80% 18.10% Not Hispanic or Latino 82.90% 82.70% 82.40% 82.20% 81.90% Source: U.S. Census Bureau. (2018). 2017 American Community Survey 1-year estimates: Table CP05. Retrieved from http://factfinder.census.gov GRAPH 7 2017 Collier County Hispanic/Latino Population Source: U.S. Census Bureau. (2018). 2017 American Community Survey 1-year estimates: Table CP05. Retrieved from http://factfinder.census.gov 28% 72% 2017 Collier County Hispanic/Latino Population Hispanic or Latino Not Hispanic or Latino 30.A.2 Packet Pg. 764 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 23 of 115 In 2050, the Hispanic or Latino population in Collier County is forecast to increase, while the non- Hispanic or Latino population is forecast to decrease. GRAPH 8 2050 Collier County Hispanic/Latino Population (Forecast Estimation) Source: Woods & Poole. (2018). 2018 State Profile: Florida [DATA FILE]. Washington, DC: Author 44% 56% 2050 Collier County Hispanic/Latino Population Hispanic or Latino Not Hispanic or Latino 30.A.2 Packet Pg. 765 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 24 of 115 In 2017, 90.30 percent of Collier County’s population was white and 7.50 percent black or African American. Since 2014, the Asian population has slightly increased from 1.60 percent to 1.80 percent in 2017. In 2017, 77.40 percent of the State of Florida’s population was white and 17.60 percent black or African American. The Asian population has slightly increased from 3.30 percent in 2014 to 3.50 percent in 2017. The United States’ population was 75.10 percent white and 14.10 percent black or African American in 2017. The Asian population has increased from 6.20 percent in 2014 to 6.60 percent of total population in 2017. TABLE 13 Race Alone or in Combination with One or More Other Races 2014 2015 2016 2017 Collier County Total population 348,777 357,305 365,136 372,880 White 86.40% 90.60% 89.00% 90.30% Black or African American 7.70% 7.50% 7.60% 7.50% American Indian and Alaska Native 0.90% 0.40% 0.40% 0.40% Asian 1.60% 1.60% 1.60% 1.80% Native Hawaiian and Other Pacific Islander 0.00% 0.00% 0.00% 0.00% Some other race 4.60% 1.20% 2.40% 1.00% Florida Total population 19,893,297 20,271,272 20,612,439 20,984,400 White 78.00% 77.80% 77.80% 77.40% Black or African American 17.40% 17.40% 17.40% 17.60% American Indian and Alaska Native 0.80% 0.80% 0.80% 0.80% Asian 3.30% 3.40% 3.40% 3.50% Native Hawaiian and Other Pacific Islander 0.20% 0.20% 0.20% 0.20% Some other race 2.90% 3.10% 3.20% 3.30% United States Total population 318,857,056 321,418,821 323,127,515 325,719,178 White 75.90% 75.80% 75.40% 75.10% Black or African American 13.90% 13.90% 14.00% 14.10% American Indian and Alaska Native 1.70% 1.70% 1.70% 1.70% Asian 6.20% 6.40% 6.50% 6.60% Native Hawaiian and Other Pacific Islander 0.40% 0.40% 0.40% 0.40% Some other race 5.20% 5.30% 5.60% 5.60% Source: U.S. Census Bureau. (2018). 2017 American Community Survey 1-year estimates: Table CP05. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 766 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 25 of 115 GRAPH 9 2017 Collier County Population by Race Source: U.S. Census Bureau. (2018). 2017 American Community Survey 1-year estimates: Table CP05. Retrieved from http://factfinder.census.gov Economic Indicator Economic Wealth Index From 2013 to 2018, Collier County has consistently had the highest Woods & Poole Wealth Index score, compared to the State of Florida and the United States. TABLE 14 Woods & Poole Economic Wealth Index 2013 2014 2015 2016 2017 2018* 2025* Collier County 175.10 172.87 173.54 173.88 174.20 181.74 183.01 Florida 97.18 96.86 96.88 96.88 96.89 97.84 98.62 United States 100 100 100 100 100 100 100 Source: Woods & Poole. (2018). 2018 State Profile: Florida [DATA FILE]. Washington, DC: Author (*Forecast Estimation) White Black or African American American Indian and Alaska Native Asian Native Hawaiian and Other Pacific Islander Some other race 2017 Collier County Population By Race 30.A.2 Packet Pg. 767 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 26 of 115 GRAPH 10 Economic Wealth Index Source: Woods & Poole. (2018). 2018 State Profile: Florida [DATA FILE]. Washington, DC: Author (*Forecast Estimation) Gross Regional Product From 2013 to 2018, Collier County and the State of Florida had a positive yearly increase in Gross Regional Product. This trend is similar to the increase of Gross Regional Product in the United States from 2013 to 2018. TABLE 15 Gross Regional Product (in millions of 2009 dollars) 2013 2014 2015 2016 2017 2018* 2025* Collier County 12,770 13,423 14,016 14,517 15,023 16,698 20,782 Florida 743,331 771,217 793,296 815,203 837,178 892,341 1,047,496 United States 15,384,326 15,894,995 16,302,781 16,696,645 17,088,653 17,602,878 19,971,767 Source: Woods & Poole. (2018). 2018 State Profile: Florida [DATA FILE]. Washington, DC: Author (*Forecast Estimation) Unemployment Since 2010, the annual unemployment rate has been consistently declining in all observed geographical areas. TABLE 16 Annual Unemployment Rate–Not Seasonally Adjusted 2010 2011 2012 2013 2014 2015 2016 2017 Collier County 11.6 10.1 8.5 7.1 6.0 5.2 4.8 4.1 Florida 11.1 10.0 8.5 7.3 6.3 5.4 4.9 4.2 United States 9.6 8.9 8.1 7.4 6.2 5.3 4.9 4.4 Source: Bureau of Labor Statistics. (2018). Labor Force Statistics from Current Population Survey. Retrieved from http://bls.gov 2013 2014 2015 2016 2017 2018*2025* Collier County 175.10 172.87 173.54 173.88 174.2 181.74 183.01 Florida 97.18 96.86 96.88 96.88 96.89 97.84 98.62 United States 100 100 100 100 100 100 100 0 20 40 60 80 100 120 140 160 180 200 30.A.2 Packet Pg. 768 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 27 of 115 The 2017-2018 monthly unemployment rate in Collier County, the State of Florida, and the United States has fluctuated throughout the year. The fluctuations in the monthly unemployment rate for Collier County, the State of Florida, and the United States follow a similar path, but during summer months the Collier County unemployment rate is above the state and national unemployment rate. GRAPH 11 2017-2018 Monthly Unemployment Rate–Not Seasonally Adjusted Source: Bureau of Labor Statistics. (2018). Labor Force Statistics from Current Population Survey. Retrieved from http://bls.gov Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul 2017 2018 Collier County 4.4 4.0 3.7 3.5 3.7 4.2 4.5 4.7 4.6 4.2 3.9 3.5 3.9 3.5 3.4 3.1 3.1 3.9 4.1 Florida 4.8 4.4 4.2 4.0 4.0 4.3 4.4 4.3 4.0 3.9 3.8 3.7 4.1 3.8 3.8 3.4 3.4 3.9 4.0 USA 5.1 4.9 4.6 4.1 4.1 4.5 4.6 4.5 4.1 3.9 3.9 3.9 4.5 4.4 4.1 3.7 3.6 4.2 4.1 3.0 3.5 4.0 4.5 5.0 5.5 6.0 Monthly Unemployement Rate2017-2018 Monthly Unemployement Rate-Not Seasonally Adjusted 30.A.2 Packet Pg. 769 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 28 of 115 Employment and Economic Opportunity From 2013 to 2017 in Collier County, the State of Florida, and the United States the unemployment rate has gradually decreased. In 2017, Collier County had the largest percentage of its population not in the labor force (47.70%), compared to the State of Florida (41.60%) and the United States (36.80%). Labor force consists of the number of individuals 16 years and over available for work. While the number of population of 16 years and over increased from 2013 to 2017 in Collier County, the percentage of labor force decreased from 53.70 percent to 52.30 percent. TABLE 17 Labor Force and Employment Status 2013 2014 2015 2016 2017 Collier County Population 16 years and over 283,561 291,946 300,290 308,016 315,591 In labor force 53.70% 53.00% 53.10% 52.30% 52.30% Civilian labor force 53.70% 53.00% 53.10% 52.30% 52.20% Employed 49.00% 49.60% 50.60% 50.40% 50.30% Unemployed 4.70% 3.40% 2.50% 2.00% 1.90% Armed Forces 0.00% 0.00% 0.00% 0.00% 0.10% Not in labor force 46.30% 47.00% 46.90% 47.70% 47.70% Florida Population 16 years and over 15,996,701 16,308,785 16,640,196 16,950,176 17,280,632 In labor force 58.90% 58.60% 58.40% 58.20% 58.40% Civilian labor force 58.60% 58.30% 58.10% 57.80% 58.10% Employed 52.90% 53.60% 54.00% 54.40% 54.90% Unemployed 5.70% 4.70% 4.10% 3.50% 3.20% Armed Forces 0.30% 0.30% 0.30% 0.40% 0.30% Not in labor force 41.10% 41.40% 41.60% 41.80% 41.60% United States Population 16 years and over 250,835,999 253,588,947 256,167,758 257,950,721 260,564,248 In labor force 63.60% 63.30% 63.10% 63.10% 63.20% Civilian labor force 63.20% 62.90% 62.70% 62.80% 62.80% Employed 57.90% 58.40% 58.80% 59.10% 59.50% Unemployed 5.30% 4.50% 3.90% 3.60% 3.30% Armed Forces 0.40% 0.40% 0.40% 0.40% 0.40% Not in labor force 36.40% 36.70% 36.90% 36.90% 36.80% Source: Census Bureau. (2018). 2017 American Community Survey: Table CP03. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 770 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 29 of 115 GRAPH 12 Labor Force Source: Census Bureau. (2018). 2017 American Community Survey: Table CP03. Retrieved from factfinder.census.gov 50.00% 52.00% 54.00% 56.00% 58.00% 60.00% 62.00% 64.00% 66.00% 2012 2013 2014 2015 2016 2017Percent of Population 16 and OverLabor Force Collier County Florida United States 30.A.2 Packet Pg. 771 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 30 of 115 In 2017, in Collier County, the State of Florida, and the United States, the number of females 16 years and over that are employed has gradually increased from the prior year. In addition, the national percentage of females 16 years and over in the labor force has also gradually increased from the prior year. TABLE 18 Females 16 Years and Over Labor Force 2013 2014 2015 2016 2017 Collier County Females 16 years and over 145,223 149,682 154,269 158,119 161,655 In labor force 48.20% 48.10% 48.80% 46.50% 47.50% Civilian labor force 48.20% 48.10% 48.80% 46.50% 47.50% Employed 44.70% 45.00% 46.00% 44.70% 45.50% Florida Females 16 years and over 8,253,942 8,419,995 8,597,749 8,751,482 8,914,426 In labor force 54.40% 54.10% 54.10% 53.70% 53.80% Civilian labor force 54.30% 54.00% 54.00% 53.60% 53.70% Employed 49.20% 49.60% 50.30% 50.30% 50.80% United States Females 16 years and over 128,595,480 130,068,058 131,333,465 132,227,193 133,482,879 In labor force 58.50% 58.20% 58.10% 58.20% 58.30% Civilian labor force 58.40% 58.10% 58.00% 58.10% 58.20% Employed 53.60% 54.00% 54.40% 54.80% 55.20% Source: Census Bureau. (2018). 2017 American Community Survey: Table CP03. Retrieved from http://factfinder.census.gov GRAPH 13 Female Labor Force Source: Census Bureau. (2018). 2017 American Community Survey: Table CP03. Retrieved from http://factfinder.census.gov 45.00% 47.00% 49.00% 51.00% 53.00% 55.00% 57.00% 59.00% 61.00% 2013 2014 2015 2016 2017Percentage of Female Population 16 and OverFemale Labor Force Collier County Florida United States 30.A.2 Packet Pg. 772 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 31 of 115 Since 2013, in Collier County, the percentage of households that have children 6-17 years old and include both parents in the labor force has continued to increase until 2015. In 2016, the percentage gradually decreased. The percentage of households with children under 6 and include both parents in the labor force increased by 15.40 percentage points from 2016 to 2017. A similar trend can be observed at the state and national level. TABLE 19 Employment Status with Own Child 2013 2014 2015 2016 2017 Collier County Own children under 6 years 19,334 19,107 18,543 19,568 18,355 All parents in family in labor force 65.30% 63.20% 71.90% 51.20% 66.60% Own children 6 to 17 years 42,381 42,296 40,873 42,514 43,172 All parents in family in labor force 68.90% 70.70% 76.20% 70.00% 68.10% Florida Own children under 6 years 1,244,079 1,242,026 1,260,973 1,287,696 1,287,270 All parents in family in labor force 65.50% 65.70% 67.10% 67.00% 65.60% Own children 6 to 17 years 2,566,147 2,595,809 2,612,599 2,629,178 2,692,941 All parents in family in labor force 71.50% 71.30% 71.40% 72.30% 71.00% United States Own children under 6 years 23,032,325 22,907,637 22,863,705 22,798,400 22,690,943 All parents in family in labor force 64.70% 64.60% 65.10% 65.50% 65.90% Own children 6 to 17 years 46,888,388 46,968,394 47,080,679 47,090,847 47,167,941 All parents in family in labor force 70.30% 70.30% 70.30% 71.00% 71.30% Source: Census Bureau. (2018). 2017 American Community Survey: Table CP03. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 773 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 32 of 115 From 2013 to 2017 in Collier County, the State of Florida, and the United States the majority of residents were employed in management, business, science, and arts occupations. They are also employed in a service occupation or a sales and office occupation. TABLE 20 Occupations 2013 2014 2015 2016 2017 Collier County Civilian employed population 16 years and over 138,998 144,750 151,828 155,130 158,695 Management, business, science and arts occupations 30.00% 30.40% 31.10% 29.10% 31.20% Service occupations 26.20% 24.50% 23.30% 27.30% 21.50% Sales and office occupations 25.30% 23.20% 23.60% 21.70% 25.50% Natural resources, construction and maintenance occupations 11.30% 14.90% 12.70% 15.00% 13.70% Production, transportation and material moving occupations 7.30% 7.00% 9.30% 6.90% 8.20% Florida Civilian employed population 16 years and over 8,459,990 8,738,970 8,990,221 9,219,488 9,488,742 Management, business, science and arts occupations 33.60% 34.20% 34.50% 34.30% 35.20% Service occupations 20.80% 20.80% 20.10% 20.60% 20.10% Sales and office occupations 27.60% 26.70% 27.00% 26.30% 25.90% Natural resources, construction and maintenance occupations 9.10% 9.10% 9.20% 9.50% 9.40% Production, transportation and material moving occupations 9.00% 9.20% 9.30% 9.30% 9.40% United States Civilian employed population 16 years and over 145,128,676 148,019,908 150,534,773 152,571,041 155,058,331 Management, business, science and arts occupations 36.30% 36.90% 37.10% 37.60% 38.20% 30.A.2 Packet Pg. 774 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 33 of 115 Service occupations 18.40% 18.20% 18.00% 18.10% 17.90% Sales and office occupations 24.20% 23.70% 23.60% 23.30% 22.90% Natural resources, construction and maintenance occupations 8.90% 8.90% 9.00% 8.80% 8.90% Production, transportation and material moving occupations 12.20% 12.30% 12.30% 12.20% 12.20% Source: Census Bureau. (2018). 2017 American Community Survey: Table CP03. Retrieved from http://factfinder.census.gov GRAPH 14 2017 Collier County Occupations Source: Census Bureau. (2018). 2017 American Community Survey: Table CP03. Retrieved from http://factfinder.census.gov 31% 22% 25% 14% 8% 2017 Collier County Occupations Management, business, science, and arts occupations Service occupations Sales and office occupations Natural resources, construction, and maintenance occupations Production, transportation, and material moving occupations 30.A.2 Packet Pg. 775 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 34 of 115 Between 2017 and 2025, nursing and residential care facilities, ambulatory healthcare services, educational services, miscellaneous manufacturing, and motor vehicle and parts dealers are projected to be the top five fastest-growing industries in Collier County. TABLE 21 Fastest-Growing Industries in Collier County Employment 2017 - 2025 Change Rank Industry 2017 2025 Total Percent 1 Nursing and Residential Care Facilities 4,246 5,473 1,227 28.9 2 Ambulatory Healthcare Services 8,914 11,437 2,523 28.3 3 Educational Services 2,104 2,591 487 23.1 4 Miscellaneous Manufacturing 1,482 1,820 338 22.8 5 Motor Vehicle and Parts Dealers 2,645 3,152 507 19.2 6 Specialty Trade Contractors 11,081 13,187 2,106 19.0 7 Social Assistance 2,101 2,484 383 18.2 8 Electronics and Appliance Stores 597 706 109 18.3 9 Health and Personal Care Stores 1,332 1,572 240 18.0 10 Transit and Ground Passenger Transport 608 717 109 17.9 11 Furniture and Home Furnishings Stores 1,413 1,663 250 17.7 12 Insurance Carriers and Related Activities 1,209 1,422 213 17.6 13 Merchant Wholesalers, Durable Goods 2,522 2,959 437 17.3 14 Professional, Scientific, and Technical Services 6,153 7,222 1,069 17.4 15 Real Estate 3,511 4,070 559 15.9 16 Sporting Goods, Hobby, Book, and Music Stores 790 914 124 15.7 17 Construction of Buildings 3,507 4,044 537 15.3 18 Administrative and Support Services 10,454 12,028 1,574 15.1 19 Building Material and Garden Supply Stores 1,777 2,043 266 15.0 20 Wholesale Electronic Markets and Agents and Brokers 270 310 40 14.8 Source: Florida Department of Economic Opportunity (2017). Labor Market Information, Employment Projections. Retrieved from: http://www.floridajobs.org/labor-market-information/data-center/statistical- programs/employment-projections 30.A.2 Packet Pg. 776 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 35 of 115 Between 2017 and 2025, ambulatory healthcare services, specialty trade contractors, food services and drinking places, administrative and support services, and local government are projected to be the top five industries gaining the most new jobs in Collier County. TABLE 22 Industries Gaining the Most New Jobs in Collier County Employment 2017 - 2025 Change Rank Industry 2017 2025 Total Percent 1 Ambulatory Healthcare Services 8,914 11,437 2,523 28.3 2 Specialty Trade Contractors 11,081 13,187 2,106 19.0 3 Food Services and Drinking Places 16,529 18,383 1,854 11.2 4 Administrative and Support Services 10,454 12,028 1,574 15.1 5 Local Government 12,258 13,614 1,356 11.1 6 Nursing and Residential Care Facilities 4,246 5,473 1,227 28.9 7 Professional, Scientific, and Technical Services 6,153 7,222 1,069 17.4 8 Amusement, Gambling, and Recreation Industries 6,945 7,724 779 11.2 9 Real Estate 3,511 4,070 559 15.9 10 Construction of Buildings 3,507 4,044 537 15.3 11 Motor Vehicle and Parts Dealers 2,645 3,152 507 19.2 12 Food and Beverage Stores 5,048 5,541 493 9.8 13 Educational Services 2,104 2,591 487 23.1 14 Merchant Wholesalers, Durable Goods 2,522 2,959 437 17.3 15 Hospitals 4,606 4,993 387 8.4 16 Social Assistance 2,101 2,484 383 18.2 17 Miscellaneous Manufacturing 1,482 1,820 338 22.8 18 Clothing and Clothing Accessories Stores 2,379 2,711 332 14.0 19 General Merchandise Stores 4,009 4,338 329 8.2 20 Personal and Laundry Services 2,264 2,545 281 12.4 Source: Florida Department of Economic Opportunity (2017). Labor Market Information, Employment Projections. Retrieved from: http://www.floridajobs.org/labor-market-information/data-center/statistical- programs/employment-projections 30.A.2 Packet Pg. 777 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 36 of 115 Between 2017 and 2025, nursing practitioners, computer-controlled machine tool operators/M & P, diagnostics medical sonographers, web developers, and home health aides are projected to be the top five fastest-growing occupations in Collier County. TABLE 23 Fastest-Growing Occupations in Collier County Employment 2017 - 2025 Rank Occupation 2017 2025 Growth Percent Growth 1 Nurse Practitioners 97 134 37 38.1 2 Computer-Controlled Machine Tool Operators, M & P 98 134 36 36.7 3 Diagnostic Medical Sonographers 99 134 35 35.4 4 Web Developers 85 115 30 35.3 5 Home Health Aides 792 1,061 269 34.0 6 Physician Assistants 96 128 32 33.3 7 Personal Care Aides 996 1,310 314 31.5 8 Healthcare Social Workers 102 134 32 31.4 9 Occupational Therapists 78 102 24 30.8 10 Brickmasons and Blockmasons 278 363 85 30.6 11 Management Analysts 738 951 213 28.9 12 Medical and Clinical Laboratory Technicians 80 102 22 27.5 13 Insulation Workers, Floor, Ceiling, and Wall 153 193 40 26.1 14 Food Servers, Nonrestaurant 401 505 104 25.9 15 Taxi Drivers and Chauffeurs 344 433 89 25.9 16 Cooks, Institution and Cafeteria 210 262 52 24.8 17 Nursing Assistants 1,544 1,925 381 24.7 18 Billing and Posting Clerks 454 565 111 24.5 19 Medical Assistants 729 907 178 24.4 20 Physical Therapists 294 365 71 24.2 Source: Florida Department of Economic Opportunity (2017). Labor Market Information, Employment Projections. Retrieved from: http://www.floridajobs.org/labor-market-information/data-center/statistical- programs/employment-projections 30.A.2 Packet Pg. 778 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 37 of 115 Between 2017 and 2025, retail salespersons, landscaping and groundskeeping workers, registered nurses, construction laborers, and combined food prep. and serving workers/fast food are projected to be the top five fastest-occupations gaining the most new jobs in Collier County. TABLE 24 Occupations Gaining the Most New Jobs in Collier County Employment 2017 - 2025 Rank Occupation 2017 2025 Growth Percent Growth 1 Retail Salespersons 7,483 8,749 1,266 16.9 2 Landscaping and Groundskeeping Workers 5,489 6,271 782 14.3 3 Registered Nurses 2,922 3,473 551 18.9 4 Construction Laborers 2,615 3,108 493 18.9 5 Combined Food Prep. and Serving Workers, Inc. Fast Food 3,217 3,696 479 14.9 6 Cooks, Restaurant 2,846 3,319 473 16.6 7 Waiters and Waitresses 5,931 6,403 472 8.0 8 Painters, Construction and Maintenance 1,908 2,343 435 22.8 9 Nursing Assistants 1,544 1,925 381 24.7 10 Carpenters 2,333 2,702 369 15.8 11 Janitors and Cleaners, Except Maids and Housekeeping 2,625 2,991 366 13.9 12 Secretaries, Except Legal, Medical, and Executive 3,467 3,830 363 10.5 13 Maids and Housekeeping Cleaners 2,537 2,885 348 13.7 14 Personal Care Aides 996 1,310 314 31.5 15 Cashiers 4,025 4,325 300 7.5 16 Office Clerks, General 3,070 3,368 298 9.7 17 First-Line Superv. of Construction and Extraction Workers 1,734 2,019 285 16.4 18 First-Line Supervisors of Retail Sales Workers 2,427 2,712 285 11.7 19 Maintenance and Repair Workers, General 2,177 2,456 279 12.8 20 Laborers and Freight, Stock, and Material Movers, Hand 1,726 1,996 270 15.6 Source: Florida Department of Economic Opportunity (2017). Labor Market Information, Employment Projections. Retrieved from: http://www.floridajobs.org/labor-market-information/data-center/statistical- programs/employment-projections 30.A.2 Packet Pg. 779 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 38 of 115 Between 2017 and 2025, switchboard operators (including answering service), postal service clerks, postal service mail carriers, travel agents, and editors are projected to be the top five declining or slow- growth occupations in Collier County. TABLE 25 Declining or Slow-Growth Occupations in Collier County Employment 2017 - 2025 Rank Occupation 2017 2025 Growth Percent Growth 1 Switchboard Operators, Including Answering Service 147 115 0 -21.8 2 Postal Service Clerks 48 39 0 -18.8 3 Postal Service Mail Carriers 372 307 0 -17.5 4 Travel Agents 95 82 0 -13.7 5 Editors 106 94 0 -11.3 6 Mail Clerks and Mail Machine Operators, Exc. Postal Service 35 32 0 -8.6 7 Tellers 648 595 0 -8.2 8 Sewing Machine Operators 114 105 0 -7.9 9 Cooks, Fast Food 369 341 0 -7.6 10 First-Line Superv. of Farming, Fishing, & Forestry Workers 71 67 0 -5.6 11 Farmworkers and Laborers, Crop, Nursery, and Greenhouse 1,620 1,529 0 -5.6 12 Molding and Casting Machine Setters and Operators; M & P 45 43 0 -4.4 13 Tax Examiners and Collectors, and Revenue Agents 31 30 0 -3.2 14 Brokerage Clerks 100 97 0 -3.0 15 Printing Press Operators 86 85 0 -1.2 16 File Clerks 177 177 0 0.0 17 Probation Officers and Correctional Treatment Specialists 43 43 0 0.0 18 Tool and Die Makers 33 33 0 0.0 19 Bookkeeping, Accounting, and Auditing Clerks 1,813 1,819 6 0.3 20 Telecommunications Equipment Installers and Repairers 99 100 1 1.0 Source: Florida Department of Economic Opportunity (2017). Labor Market Information, Employment Projections. Retrieved from: http://www.floridajobs.org/labor-market-information/data-center/statistical- programs/employment-projections 30.A.2 Packet Pg. 780 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 39 of 115 Compensation Since 2012, the average annual pay in Collier County has been below Florida average annual pay. During the same time frame, average weekly pay was also below state average. TABLE 26 Average Annual Pay 2012 2013 2014 2015 2016 2017 Collier County $41,778 $43,214 $43,934 $45,020 $45,427 $46,415 Florida $43,211 $43,649 $44,803 $46,260 $47,035 $48,455 Source: Bureau of Labor Statistics. (2018). Quarterly Census of Employment & Wages. Retrieved from http://www. bls.gov GRAPH 15 Average Annual Pay Source: Bureau of Labor Statistics. (2018). Quarterly Census of Employment & Wages. Retrieved from http://www. bls.gov $39,000 $40,000 $41,000 $42,000 $43,000 $44,000 $45,000 $46,000 $47,000 $48,000 $49,000 2012 2013 2014 2015 2016 2017Annual PayAverage Annual Pay Collier County Florida 30.A.2 Packet Pg. 781 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 40 of 115 TABLE 27 Average Weekly Pay 2012 2013 2014 2015 2016 2017 Collier County $803 $831 $845 $866 $874 $893 Florida $831 $839 $862 $890 $905 $932 Source: Bureau of Labor Statistics. (2018). Quarterly Census of Employment & Wages. Retrieved from http://www. bls.gov GRAPH 16 Average Weekly Pay Source: Bureau of Labor Statistics. (2018). Quarterly Census of Employment & Wages. Retrieved from http://www. bls.gov $750 $770 $790 $810 $830 $850 $870 $890 $910 $930 $950 2012 2013 2014 2015 2016 2017Weekly PayAverage Weekly Pay Collier County Florida 30.A.2 Packet Pg. 782 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 41 of 115 TABLE 28 Collier County Subdivisions–Median Income 2013 2014 2015 2016 Everglades CCD Household Total $51,188 $51,800 $50,665 $50,809 Hispanic or Latino Origin (of any race) $31,478 $34,221 $32,073 $33,523 White alone, not Hispanic or Latino $54,403 $54,053 $55,282 $52,967 Immokalee CCD Household Total $49,432 $54,148 $57,557 $61,219 Hispanic or Latino Origin (of any race) $36,123 $36,697 $37,724 $40,058 White alone, not Hispanic or Latino $69,024 $76,035 $91,523 $83,352 Marco Island CCD Household Total $68,478 $72,377 $72,500 $72,882 Hispanic or Latino Origin (of any race) $52,031 $52,066 $61,709 $45,313 White alone, not Hispanic or Latino $69,485 $73,337 $73,516 $75,836 Naples CCD Household Total $56,123 $55,756 $56,891 $59,356 Hispanic or Latino Origin (of any race) $40,664 $40,721 $41,200 $42,504 White alone, not Hispanic or Latino $61,266 $61,636 $62,870 $65,128 Source: U.S. Census Bureau. (2018). 2016 American Community Survey 5-year Estimates: Table S1903. Retrieved from http://factfinder.census.gov Housing Poverty and Homelessness From 2011 to 2017, the United States and the State of Florida have had a downward trend in the point in time estimates of homeless people. From 2011 to 2017, the point-in-time estimates for Naples/Collier County has fluctuated. TABLE 29 Point-in-Time Estimates of Homeless People 2011 2012 2013 2014 2015 2016 2017 Naples/Collier County 390 455 396 361 389 545 621 Florida 56,687 55,170 47,862 41,542 35,900 33,559 32,190 United States 625,217 622,982 591,768 578,424 564,708 549,928 553,742 Source: The U.S. Department of Housing and Urban Development. (2018). The 2017 Annual Homeless Assessment Report (AHAR) to Congress. Retrieved from https://www.hudexchange.info 30.A.2 Packet Pg. 783 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 42 of 115 In 2017, Florida was ranked as the state with the second highest rate of unsheltered homeless people (46.8%). TABLE 30 Highest Rates of Unsheltered Homeless People by State in 2017 States With the Highest Rates # of Homeless People # of Unsheltered Homeless People % of Homeless People who were Unsheltered California 134,278 91,642 68.2% Florida 32,190 15,079 46.8% Texas 23,548 8,493 36.1% Washington 21,112 8,591 40.7% Oregon 13,953 7,967 57.1% Source: The U.S. Department of Housing and Urban Development. (2018). The 2017 Annual Homeless Assessment Report (AHAR) to Congress. Retrieved from https://www.hudexchange.info In 2017, Florida was ranked as the state with the second highest rate of unsheltered homeless people in families (34.4%). TABLE 31 Highest Rates of Unsheltered Homeless People in Families by State in 2017 States With the Highest Rates # of Homeless People in Families # of Unsheltered Homeless People in Families % of Homeless People in Families who were Unsheltered California 21,522 3,908 18.2% Florida 9,422 3,242 34.4% Texas 6,840 499 7.3% Washington 6,331 543 8.6% Oregon 3,519 1,826 51.9% Source: The U.S. Department of Housing and Urban Development. (2018). The 2017 Annual Homeless Assessment Report (AHAR) to Congress. Retrieved from https://www.hudexchange.info The Collier County homeless students reported in Florida public schools has begun to gradually increase since 2015-2016. TABLE 32 Collier County Homeless Students Reported in Florida Public Schools by Florida County 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 Collier 1,123 849 779 808 900 Source: Florida Department of Children and Families. (2018). Council on Homelessness 2018 Annual Report. Retrieved from http://www.dcf.state.fl.us/ 30.A.2 Packet Pg. 784 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 43 of 115 In 2016, the largest cause of homelessness in the State of Florida was employment/financial difficulties. This was followed by medical/disability, family problems, and forced relocation. TABLE 33 Causes of Homelessness in Florida 2016 Number 2016 Percentage 2015 Percentage Employment/Financial 8,393 44.5% 41.5% Medical/Disability 4,111 21.8% 17.5% Family Problems 3,306 17.5% 19.6% Forced to Relocate 2,714 14.4% 19.6% Recent Immigration 109 0.6% 1.0% Natural Disaster 212 1.1% 0.8% Source: Florida Department of Children and Families. (2018). Council on Homelessness 2016 Annual Report. Retrieved from http://www.dcf.state.fl.us/ GRAPH 17 2016 Causes of Homelessness in Florida Source: Florida Department of Children and Families. (2018). Council on Homelessness 2016 Annual Report. Retrieved from http://www.dcf.state.fl.us/ 44.50% 21.80% 17.50% 14.40% 0.60%1.10% 2016 Causes of Homelessness in Florida Employment/Financial Medical/Disability Family Problems Forced to Relocate Recent Immigration Natural Disaster 30.A.2 Packet Pg. 785 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 44 of 115 TABLE 34 Total Percentage of Poverty by Age Group Region/ Year 18 to 24 years 25 to 34 years 35 to 44 years 45 to 54 years 55 to 64 years Collier County 2011 21.4% 15.7% 18.7% 12.8% 12.0% 2012 16.0% 18.0% 15.2% 12.5% 9.5% 2013 13.8% 12.9% 17.0% 11.8% 8.3% 2014 18.8% 18.0% 16.8% 11.7% 9.9% 2015 19.0% 18.0% 18.4% 10.0% 11.4% 2016 11.6% 13.4% 13.6% 8.9% 11.5% 2017 13.5% 14.0% 12.6% 9.9% 9.5% Florida 2011 24.0% 17.0% 15.3% 13.6% 12.3% 2012 24.0% 17.7% 14.4% 13.2% 13.1% 2013 22.8% 17.2% 15.3% 13.6% 13.3% 2014 22.5% 16.3% 14.6% 13.0% 13.6% 2015 21.2% 15.7% 13.5% 12.3% 12.6% 2016 39.6% 14.1% 12.8% 11.4% 12.9% 2017 18.1% 13.2% 12.0% 11.0% 12.2% United States 2011 23.6% 16.0% 13.1% 11.4% 10.2% 2012 23.1% 16.0% 13.1% 11.3% 10.6% 2013 22.8% 15.9% 13.3% 11.4% 10.8% 2014 22.3% 15.4% 13.0% 11.2% 11.0% 2015 21.0% 14.5% 12.3% 10.7% 10.7% 2016 19.8% 13.5% 11.7% 10.1% 10.8% 2017 18.9% 12.7% 11.1% 9.7% 10.5% Source: U.S. Census Bureau. (2018). 2017 American Community Survey 1-year estimates: Table B17001. Retrieved from http://factfinder.census.gov/; U.S. Census Bureau. (2018). 2017 American Community Survey 1-year estimates: Table B01001. Retrieved from http://factfinder.census.gov/ Note. Year-to-year percentage changes were calculated by the research team. 30.A.2 Packet Pg. 786 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 45 of 115 TABLE 35 Below Poverty Level by Employment Status Region/ Sex 2012 2013 2014 2015 2016 2017 Collier County Male 5,108 6,106 7,149 7,861 6,162 5,099 Female 4,300 5,617 5,973 5,325 4,573 6,996 Both 9,408 11,723 13,122 13,186 10,735 12,095 Florida Male 313,112 327,455 328,290 301,587 302,395 277,659 Female 357,247 364,739 382,985 373,821 349,961 331,300 Both 670,359 692,194 711,275 675,408 652,356 608,959 United States Male 4,809,449 4,948,486 5,007,735 4,700,888 4,483,921 4,193,809 Female 5,742,964 5,924,357 6,058,649 5,831,441 5,593,732 5,318,283 Both 10,552,413 10,872,843 11,066,384 10,532,329 10,077,653 9,512,092 Source: U.S. Census Bureau. (2018). 2017 American Community Survey1-year estimates: Table: S1701. Retrieved from http://factfinder.census.gov/ Housing Cost and Foreclosure The majority of households spend less than 30 percent of household income on housing. However, the number of households spending more than 50 percent of household income on housing cost is increasing, and it is projected to increase. TABLE 36 Housing Cost Burden 2010 2015 2016 2020* 2025* Collier County 30% or less 79,515 86,170 87,962 96,204 105,789 30.1 – 50% 27,486 29,436 30,025 32,696 35,716 More than 50% 26,176 28,165 28,724 31,255 34,114 Florida 30% or less 4,316,936 4,616,994 4,707,554 5,063,356 5,466,597 30.1 – 50% 1,515,330 1,614,513 1,645,848 1,766,440 1,902,121 More than 50% 1,581,574 1,686,079 1,718,537 1,840,853 1,980,335 Source: Florida Housing Data Clearinghouse. (2018). Household Demographic Data- Households by tenure, age of householder, income, and cost burden. Retrieved from: http://flhousingdata.shimberg.ufl.edu. (*Forecast Estimation) 30.A.2 Packet Pg. 787 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 46 of 115 GRAPH 18 Collier County Housing Cost Burden as Percentage of Household Income–Population 65+ Source: Florida Housing Data Clearinghouse. (2018). Household Demographic Data-Households by tenure, age of householder, income, and cost burden. Retrieved from: http://flhousingdata.shimberg.ufl.edu. (*Forecast Estimation) Collier County’s foreclosure rate is above the state and national rate. In Collier County, the pre- foreclosure percentage from the prior month decreased by 37.2 percent. Additionally, the pre-foreclosure percentage from the prior year increased by 35.0 percent. Median home prices in Collier County are above the state and national home prices. TABLE 37 Foreclosure Status Distribution–August 2018 Collier County Florida United States Foreclosure Rates 1 in 2796 1 in 1209 1 in 1882 Pre-Foreclosure Current 38.6% 46.5% 32.1% Prior month 37.2% 7.2% 7.9% Prior Year 35.0% 3.5% 5.2% Auction Current 34.3% 24.9% 37.0% Prior month 4.0% 4.0% 6.6% Prior Year 4.0% 21.6% 11.5% Bank-Owned Current 27.1% 28.7% 30.8% Prior month 5.6% 1.6% 13.8% Prior Year 11.8% 15.8% 1.5% Source: RealtyTrac (2018). U.S. Real Estate Trends and Market Info: Foreclosure rates. Retrieved from http://www.realtytrac.com/statsandtrends/foreclosuretrends 2010 2015 2016 2020*2025* 30% or less 34,618 38,978 39,978 44,572 51,228 30.1 –50%8,501 9,566 9,811 10,934 12,556 More than 50%9,780 10,995 11,276 12,548 14,369 0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 50,000 PercentageCollier County Housing Cost Burden as Percentage of Household Income-Population 65+ 30.A.2 Packet Pg. 788 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 47 of 115 TABLE 38 Median Home Prices–August 2018 Median List Price Median Sales Price Median Foreclosure Sales Price Collier County $395,000 $324,720 - Florida $249,900 $210,000 - United States $262,888 $248,100 - Source: RealtyTrac (2018). U.S. Real Estate Trends and Market Info: Foreclosure rates. Retrieved from http://www.realtytrac.com/statsandtrends/foreclosuretrends *Data was not available for Median Foreclosure Sales Price Environment Protected Land and Conservations The State of Florida has 29.1 percent of its region designated as protected land, compared to 9.7 percent of the Southeast portion of the United States, and 20.5 percent of the United States total. TABLE 39 Protected Land Almanac Total Acres Protected Protected Acres per Capita % of Region Protected Florida 10,049,676 0.55 29.1% U.S. Southeast 28,960,509 0.43 9.7% U.S. Total 473,653,971 1.57 20.5% Source: Conservation Almanac (2018). Almanac. Conservation Almanac Tracking Investments in Protected Lands. Retrieved from http://www.conservationalmanac.org (County data not available at time of report) 30.A.2 Packet Pg. 789 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 48 of 115 GRAPH 19 Collier County Map of Protected Land This map was created on October 1, 2018, using the Conservation Almanac Interactive Mapping site. Information on the map is for discussion and visualization purposes only. 2018 The Trust for Public Land. TPL, The Trust for Public Land, and The Trust for Public Land logo are trademarks of The Trust for Public Land. http://www.tpl.org Collier County has 68 percent of its land designated as conservation land, compared to the State of Florida, which has 28 percent of its land designated as conservation land. TABLE 40 Conservation Land by Lead Managing Agency in Acres Local State Federal Private Total Conservation Area Total % of Area Collier County 4,490 213,750 648,130 12,480 878,850 1,296,640 68% Florida 495,466 4,890,173 4,061,780 127,777 9,575,196 34,721,280 28% Sources: Florida Natural Areas Inventory. (2018). Acres of conservation lands by county. Retrieved from http://fnai.org; Florida Natural Areas Inventory. (2018). Summary of Florida Conservation Lands. Retrieved from http://fnai.org 30.A.2 Packet Pg. 790 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 49 of 115 Healthcare As of September 5, 2018, 5.22 percent of Collier County’s total registered nonprofit organizations were designated as “Health and Mental Health,” organizations. This is less than the State of Florida, which has 6.49 percent and the United States with 6.18 percent. TABLE 41 Registered Nonprofit Organizations in Health and Mental Health Healthcare Mental Health & Crisis Intervention Voluntary Health Association & Medical Disciplines Medical Research Total Registered Nonprofit Organizations Collier County 41 16 28 4 1,706 Florida 2,066 985 2,051 224 82,056 United States 45,312 17,233 30,876 4,284 1,581,445 Source: Internal Revenue Service, (2018). Exempt organizations business master file, The Urban Institute. National Center for Charitable Statistics. Retrieved from http://nccsdataweb.urban.org County Health Ranking In 2013, Collier County was ranked third among 67 Florida counties in regards to health outcomes. The county’s health outcomes ranking has dropped to second and has maintained the same ranking until now. In 2013, Collier County was ranked 10th in Florida in measured health factors and since then has improved to be ranked third among 67 Florida counties. GRAPH 20 Collier County Overall Health Outcomes and Health Factors Ranking Among 67 Florida Counties Source: University of Wisconsin Population Health Institute. (2018). County Health Rankings & Roadmaps. Retrieved from http://www.countyhealthrankings.org 10 8 6 5 5 3 3 2 2 2 2 2 2013 2014 2015 2016 2017 2018 Collier County Overall Health Outcomes and Health Factors Ranking Among 67 Florida Counties Health Outcomes Health Factors Well-------------------------------------------------------------------------Worse 30.A.2 Packet Pg. 791 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 50 of 115 Collier County’s ranking among 67 Florida counties for length of life has maintained the same ranking since 2017. The ranking for quality of life improved from ninth in 2017 to third in 2018. GRAPH 21 Collier County Health Outcomes Components Ranking Among 67 Florida Counties Source: University of Wisconsin Population Health Institute. (2018). County Health Rankings & Roadmaps. Retrieved from http://www.countyhealthrankings.org 4 7 7 8 9 3 1 1 3 3 1 1 2013 2014 2015 2016 2017 2018 Collier County Health Outcomes Components Ranking Among 67 Florida Counties Length of Life Quality of Life Well-------------------------------------------------------------------------Worse 30.A.2 Packet Pg. 792 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 51 of 115 In 2017, Collier County was ranked 17th of 67 Florida counties in regards to clinical care; however, decreased to 21st in 2018. Since 2014, Collier County improved state ranking in relation to physical environment from 11th to sixth. In 2013, Collier County was ranked 30th in social and economic factors; however, increased to 13th in 2018. GRAPH 22 Collier County Health Factors Components Ranking Among 67 Florida Counties Source: University of Wisconsin Population Health Institute. (2018). County Health Rankings & Roadmaps. Retrieved from http://www.countyhealthrankings.org Reported Health Issues In 2015, 2016, and 2018, Collier County and the United States had the same percentage of its population reporting poor or fair health. Since 2017, Florida’s percentage increased from 17.0 to 19.0. TABLE 42 Population Reporting Poor or Fair Health in Percent 2014 2015 2016 2017 2018 Collier County 16.8 17.0 16.0 15.0 16.0 Florida 15.9 16.0 18.0 17.0 19.0 United States 17.3 17.0 16.0 16.0 16.0 Source: University of Wisconsin Population Health Institute. (2018). County Health Rankings & Roadmaps. Retrieved from http://www.countyhealthrankings.org 5 3 3 2 2 1 17 19 21 18 17 21 30 18 18 21 18 13 5 11 8 5 6 6 2013 2014 2015 2016 2017 2018 Collier County Health Outcomes Components Ranking Among 67 Florida Counties Physical Environment Social & Economic Factors Clinical Care Health Behavior Well-------------------------------------------------------------------------Worse 30.A.2 Packet Pg. 793 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 52 of 115 GRAPH 23 Reported Poor or Fair Health Source: University of Wisconsin Population Health Institute. (2018). County Health Rankings & Roadmaps. Retrieved from http://www.countyhealthrankings.org From 2014 to 2018, Collier County has either matched or been below the State of Florida and the United States reported poor physical and mental health days per month. TABLE 43 Reported Poor Physical and Mental Health Days per Month 2014 2015 2016 2017 2018 Collier County Poor physical health days 3.4 3.4 3.5 3.6 3.5 Poor mental health days 3.6 3.6 3.7 4.0 3.5 Florida Poor physical health days 3.7 3.7 3.9 4.2 3.8 Poor mental health days 3.8 3.8 3.9 4.2 3.8 United States Poor physical health days 3.8 3.8 3.7 3.8 3.7 Poor mental health days 3.6 3.6 3.7 3.8 3.8 Source: University of Wisconsin Population Health Institute. (2018). County Health Rankings & Roadmaps. Retrieved from http://www.countyhealthrankings.org 14.5 15.5 16.5 17.5 18.5 19.5 2014 2015 2016 2017 2018 Reported Poor or Fair Health Collier County Florida United States 30.A.2 Packet Pg. 794 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 53 of 115 GRAPH 24 Reported Poor Physical Health Days Source: University of Wisconsin Population Health Institute. (2018). County Health Rankings & Roadmaps. Retrieved from http://www.countyhealthrankings.org GRAPH 25 Reported Poor Mental Health Days Source: University of Wisconsin Population Health Institute. (2018). County Health Rankings & Roadmaps. Retrieved from http://www.countyhealthrankings.org 3 3.2 3.4 3.6 3.8 4 4.2 4.4 2014 2015 2016 2017 2018 Reported Poor Physical Health Days Collier County Florida United States 3 3.2 3.4 3.6 3.8 4 4.2 4.4 2014 2015 2016 2017 2018 Reported Poor Mental Health Days Collier County Florida United States 30.A.2 Packet Pg. 795 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 54 of 115 From 2014 to 2018, Collier County has consistently had a lower obese population than the State of Florida and the United States. TABLE 44 Adult Obesity–Percent of Population 2014 2015 2016 2017 2018 Collier County 20.9 20.0 19.0 20.0 20.0 Florida 25.8 26.0 25.0 26.0 26.0 United States 30.6 31.0 31.0 31.0 28.0 Source: University of Wisconsin Population Health Institute. (2018). County Health Rankings & Roadmaps. Retrieved from http://www.countyhealthrankings.org From 2014 to 2018, Collier County has consistently had a lower percentage of low birth weight as a percent of total births, compared to the State of Florida and the United States. TABLE 45 Low Birth Weight as Percentage of Total Births 2014 2015 2016 2017 2018 Collier County 7.1 7.0 7.0 7.0 7.0 Florida 8.7 8.7 9.0 9.0 9.0 United States 8.3 8.3 8.0 8.0 8.0 Source: University of Wisconsin Population Health Institute. (2018). County Health Rankings & Roadmaps. Retrieved from http://www.countyhealthrankings.org From 2015 to 2017, Collier County’s reported alcohol consumption was consistent with 18.0 percent of its population reporting excessive alcohol consumption; however, the percentage decreased to 15.0 in 2018. TABLE 46 Reported Excessive Alcohol Consumption (percent of total population) 2014 2015 2016 2017 2018 Collier County 17.5 18.0 18.0 18.0 15.0 Florida 15.9 16.0 17.0 17.0 18.0 United States 16.5 17.0 17.0 17.0 18.0 Source: University of Wisconsin Population Health Institute. (2018). County Health Rankings & Roadmaps. Retrieved from http://www.countyhealthrankings.org 30.A.2 Packet Pg. 796 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 55 of 115 Compared to the State of Florida, Collier County had the highest teen birth rate in 2014 and 2015; however, this rate has steadily declined. TABLE 47 Teen Birth Rate as Percentage 2014 2015 2016 2017 2018 Collier County 43.9 39.0 34.0 30.0 24.0 Florida 38.1 36.0 34.0 31.0 25.0 United States 44.4 43.4 42.0 39.0 27.0 Source: University of Wisconsin Population Health Institute. (2018). County Health Rankings & Roadmaps. Retrieved from http://www.countyhealthrankings.org GRAPH 26 Teen Birth Rate as Percentage Source: University of Wisconsin Population Health Institute. (2018). County Health Rankings & Roadmaps. Retrieved from http://www.countyhealthrankings.org From 2011 to 2012, Collier County has generally had the least percent of its population reporting inadequate social support, compared to Florida and the United States; however, between 2013 and 2014, Collier County’s percent was 0.2 percent higher than the United States. TABLE 48 Population Reporting Inadequate Social Support in Percent of Total Population 2011 2012 2013 2014 Collier County 19.0% 19.2% 19.5% 19.5% Florida 21.4% 21.2% 21.5% 21.4% United States 19.5% 19.4% 19.3% 19.3% Source: University of Wisconsin Population Health Institute. (2018). County Health Rankings & Roadmaps. Retrieved from http://www.countyhealthrankings.org 20 25 30 35 40 45 50 2014 2015 2016 2017 2018 Teen Birth Rate Collier County Florida United States 30.A.2 Packet Pg. 797 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 56 of 115 From 2015 to 2018, Collier County had the highest ratio of primary care physicians to population, compared to the State of Florida and the United States. TABLE 49 Primary Care Physicians 2015 2016 2017 2018 Collier Number 231 237 239 254 Ratio 1439:1 1430:1 1460:1 1410:1 Florida Number 13,578 14,094 14,428 14,728 Ratio 1423:1 1390:1 1380:1 1380:1 United States Number 233,862 239,500 241,107 242,500 Ratio 2015:1 1990:1 2030:1 1320:1 Source: University of Wisconsin Population Health Institute. (2018). County Health Rankings & Roadmaps. Retrieved from http://www.countyhealthrankings.org Collier County has consistently had the highest ratio of mental healthcare providers to population, compared to the State of Florida and the United States. The amount of mental health providers has been increasing from 2016 to 2018. TABLE 50 Mental Healthcare Providers 2015 2016 2017 2018 Collier Number 270 292 313 338 Ratio 1258:1 1190:1 1140:1 1080:1 Florida Number 22,913 24,985 27,120 29,306 Ratio 853:1 800:1 750:1 700:1 United States Number 552,104 593,720 641,686 692,029 Ratio 1128:1 1060:1 1105:1 470:1 Source: University of Wisconsin Population Health Institute. (2018). County Health Rankings & Roadmaps. Retrieved from http://www.countyhealthrankings.org 30.A.2 Packet Pg. 798 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 57 of 115 From 2015 to 2018, there was a dramatic increase in mental healthcare providers in Collier County. From 2015 to 2018, the amount of primary care physicians in Collier County stayed relatively constant. GRAPH 27 Collier County Primary Care Physicians and Mental Healthcare Providers Physicians Source: University of Wisconsin Population Health Institute. (2018). County Health Rankings & Roadmaps. Retrieved from http://www.countyhealthrankings.org - 50 100 150 200 250 300 350 400 2015 2016 2017 2018 Collier County Primary Care Physicians and Mental Healthcare Providers Collier PCP Collier MHP 30.A.2 Packet Pg. 799 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 58 of 115 Health Insurance In 2017, the percentage of males without health insurance decreased for the age groups under 6 years, 6 to 17 years, 25 to 34 years, 35 to 44 years, 45 to 54 years, 55 to 64 years, and 65 to 74 years. The female age groups 6 to 17 years, 35 to 44 years, 65 to 74 years, and 75 years and over also had a percentage decrease of individuals without health insurance. TABLE 51 Collier County–Percent No Health Insurance by Sex and Age 2014 2015 2016 2017 Male Under 6 years 3.57% 7.02% 9.43% 5.94% 6 to 17 years 16.51% 15.27% 10.66% 10.40% 18 to 24 years 33.45% 35.88% 28.07% 37.74% 25 to 34 years 51.62% 41.18% 44.90% 40.84% 35 to 44 years 40.74% 37.39% 37.37% 35.77% 45 to 54 years 27.48% 33.95% 26.08% 25.42% 55 to 64 years 20.21% 14.53% 20.60% 14.00% 65 to 74 years 0.81% 1.25% 3.34% 0.08% 75 years and over 0.92% 0.45% 0.16% 2.54% Female Under 6 years 3.77% 6.31% 4.40% 8.69% 6 to 17 years 14.81% 16.41% 17.02% 13.67% 18 to 24 years 39.41% 20.31% 34.66% 45.90% 25 to 34 years 38.39% 29.99% 29.77% 32.36% 35 to 44 years 37.42% 34.72% 27.52% 25.86% 45 to 54 years 17.84% 18.98% 16.27% 24.47% 55 to 64 years 16.35% 12.66% 12.55% 14.54% 65 to 74 years 2.08% 1.83% 1.56% 0.16% 75 years and over 1.86% 0.31% 1.23% 0.93% Source: U.S. Census Bureau. (2018). 2017 American Community Survey 1-year estimates: Table B27001. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 800 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 59 of 115 In the State of Florida from 2014 to 2017, the male and female population percentages without health insurance were highest for ages 18-24, 25-34, and 35-44. TABLE 52 Florida–Percent No Health Insurance by Sex and Age 2014 2015 2016 2017 Male Under 6 years 6.74% 4.81% 5.11% 5.85% 6 to 17 years 10.68% 7.66% 6.77% 8.21% 18 to 24 years 29.30% 24.12% 21.91% 23.40% 25 to 34 years 34.76% 29.61% 27.37% 27.94% 35 to 44 years 28.49% 24.13% 23.21% 23.56% 45 to 54 years 22.92% 19.12% 17.74% 18.67% 55 to 64 years 16.66% 12.73% 12.87% 14.00% 65 to 74 years 1.68% 1.74% 1.56% 1.24% 75 years and over 0.87% 0.74% 0.75% 0.86% Female Under 6 years 7.20% 5.42% 4.32% 5.69% 6 to 17 years 10.23% 7.94% 7.06% 7.70% 18 to 24 years 24.96% 19.25% 17.96% 19.61% 25 to 34 years 24.72% 20.60% 19.71% 20.27% 35 to 44 years 22.46% 18.35% 16.77% 17.59% 45 to 54 years 20.50% 16.45% 16.14% 15.98% 55 to 64 years 16.73% 12.40% 12.64% 13.46% 65 to 74 years 1.89% 1.77% 1.93% 1.63% 75 years and over 1.17% 0.92% 0.76% 0.85% Source: U.S. Census Bureau. (2018). 2017 American Community Survey 1-year estimates: Table B27001. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 801 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 60 of 115 In the United States from 2014 to 2017, the male and female population percentages without health insurance were highest for ages 18-24, 25-34 and 35-44. TABLE 53 United States–Percent No Health Insurance by Sex and Age 2014 2015 2016 2017 Male Under 6 years 6.49% 3.97% 3.82% 4.11% 6 to 17 years 20.96% 5.26% 4.81% 5.50% 18 to 24 years 25.04% 16.82% 14.74% 15.95% 25 to 34 years 19.46% 20.70% 18.39% 18.45% 35 to 44 years 14.87% 16.45% 15.40% 15.53% 45 to 54 years 10.25% 12.15% 11.40% 11.69% 55 to 64 years 1.07% 8.19% 7.86% 8.21% 65 to 74 years 0.61% 0.99% 0.92% 0.90% 75 years and over 4.95% 0.52% 0.44% 0.52% Female Under 6 years 4.95% 4.04% 3.81% 4.12% 6 to 17 years 6.55% 5.12% 4.72% 5.35% 18 to 24 years 16.77% 13.13% 11.55% 12.49% 25 to 34 years 18.09% 14.34% 12.93% 12.93% 35 to 44 years 15.45% 12.69% 11.82% 11.89% 45 to 54 years 13.06% 10.17% 9.52% 9.77% 55 to 64 years 10.01% 7.65% 7.17% 7.54% 65 to 74 years 1.23% 1.05% 1.01% 0.95% 75 years and over 0.68% 0.63% 0.55% 0.59% Source: U.S. Census Bureau. (2018). 2017 American Community Survey 1-year estimates: Table B27001. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 802 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 61 of 115 From 2012 to 2015, the highest percentage of adults who could not see the doctor due to cost was in the State of Florida, followed by Collier County and the United States. GRAPH 28 Adults Could Not See a Doctor Due to Cost Source: University of Wisconsin Population Health Institute. (2018). County Health Rankings & Roadmaps. Retrieved from http://www.countyhealthrankings.org Total current health expenditure as percent of GDP has increased 0.3 percent in 2016. TABLE 54 Total U.S. Current Health Expenditure as Percent of Gross Domestic Product 2012 2013 2014 2015 2016 Private Sector 8.5 8.4 3.1 3.0 3.1 General Government 7.9 8.0 13.4 13.8 14.0 Total Expenditure 16.4 16.4 16.5 16.8 17.1 Source: Organization for Economic Co-operation and Development. (2018). Health Expenditure and Financing [custom table]. Retrieved from stats.oecd.org 10.0% 11.0% 12.0% 13.0% 14.0% 15.0% 16.0% 17.0% 18.0% 2012 2013 2014 2015 Adults could not see a doctor due to cost Collier County Florida United States 30.A.2 Packet Pg. 803 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 62 of 115 GRAPH 29 Total U.S. Current Health Expenditure as Percent of Gross Domestic Product Source: Organization for Economic Co-operation and Development. (2018). Health Expenditure and Financing [custom table]. Retrieved from stats.oecd.org 8.58.43.13.03.17.98.013.413.814.02012 2013 2014 2015 2016 Total Current Health Expenditure as % of GDP Private Sector General Government 30.A.2 Packet Pg. 804 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 63 of 115 The projected income and projected healthcare-related expenses for Collier County, Florida, and the United States are anticipated to increase in 2023. TABLE 55 2018A Household and Healthcare Demographics and 2023 Demographic Household and Healthcare Estimates–Collier County 2018A 2023 Collier County Household Demographics Total Households 154,740 - Average Household Income $100,437 - Median Household Income $62,406 - Healthcare Consumer Expenditure Total Healthcare $4,672.29 $5,551.42 As percentage of Average Household Income 4.65% - As percentage of Median Household Income 7.49% - Healthcare Detail Healthcare Insurance $3,352.87 $4,011.53 As percentage of Average Household Income 3.34% - As percentage of Median Household Income 5.37% - Medical Services $693.39 $808.28 As percentage of Average Household Income 0.69% - As percentage of Median Household Income 1.11% - Medical Supplies $158.58 $193.73 As percentage of Average Household Income 0.16% - As percentage of Median Household Income 0.25% - Source: DemographicsNow. (2018). Collier County, FL, Florida and Entire US CEX - Healthcare Detail Comparison [Data]. Retrieved September 17, 2018 from DemographicsNow database. 30.A.2 Packet Pg. 805 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 64 of 115 TABLE 56 2018A Household and Healthcare Demographics and 2023 Demographic Household and Healthcare Estimates–Florida 2018A 2023 Florida Household Demographics Total Households 8,171,488 - Average Household Income $74,651 - Median Household Income $51,707 - Healthcare Consumer Expenditure Total Healthcare $4,216.06 $5,050.00 As percentage of Average Household Income 5.65% - As percentage of Median Household Income 8.15% - Healthcare Detail Healthcare Insurance $3,002.32 $3,624.37 As percentage of Average Household Income 4.02% - As percentage of Median Household Income 5.81% - Medical Services $642.61 $755.10 As percentage of Average Household Income 0.86% - As percentage of Median Household Income 1.24% - Medical Supplies $129.72 $159.55 As percentage of Average Household Income 0.17% - As percentage of Median Household Income 0.25% - Source: DemographicsNow. (2018). Florida and Entire US CEX - Healthcare Detail Comparison [Data]. Retrieved September 17, 2018 from DemographicsNow database. 30.A.2 Packet Pg. 806 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 65 of 115 TABLE 57 2018A Household and Healthcare Demographics and 2023 Demographic Household and Healthcare Estimates–United States 2018A 2023 United States Household Demographics Total Households 123,611,231 - Average Household Income $84,609 - Median Household Income $58,754 - Healthcare Consumer Expenditure Total Healthcare $4,598.78 $5,566.56 As percentage of Average Household Income 5.44% As percentage of Median Household Income 7.83% Healthcare Detail Healthcare Insurance $3,153.16 $3,814.27 As percentage of Average Household Income 3.73% - As percentage of Median Household Income 5.37% - Medical Services $838.76 $1,014.48 As percentage of Average Household Income 0.99% - As percentage of Median Household Income 1.43% - Medical Supplies $149.74 $186.78 As percentage of Average Household Income 0.18% - As percentage of Median Household Income 0.25% - Source: DemographicsNow. (2018). Entire US CEX - Healthcare Detail Comparison [Data]. Retrieved September 17, 2018 from DemographicsNow database. 30.A.2 Packet Pg. 807 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 66 of 115 The costs for health insurance plans, health maintenance plans, Medicare payments, and Medicare supplements are projected to increase in 2023 for Collier County, Florida, and the United States. TABLE 58 Healthcare Insurance 2018A Statistics and 2023 Estimates 2018A 2023 Collier County Blue Cross / Blue Shield $ 852.83 $ 990.13 Commercial Health Insurance $ 438.76 $ 524.78 Health Maintenance Plans $ 660.88 $ 781.67 Medicare Payments $ 771.90 $ 935.36 Medicare Supplements $ 271.79 $ 331.54 Florida Blue Cross / Blue Shield $ 851.91 $ 997.61 Commercial Health Insurance $ 409.58 $ 492.22 Health Maintenance Plans $ 628.56 $ 747.97 Medicare Payments $ 623.37 $ 769.63 Medicare Supplements $ 218.17 $ 270.84 United States Blue Cross / Blue Shield $ 968.37 $ 1,156.57 Commercial Health Insurance $ 593.74 $ 706.35 Health Maintenance Plans $ 635.00 $ 756.38 Medicare Payments $ 528.63 $ 656.20 Medicare Supplements $ 206.36 $ 256.73 Source: DemographicsNow. (2018). Collier County, FL, Florida and Entire US CEX - Healthcare Detail Comparison [Data]. Retrieved September 17, 2018 from DemographicsNow database. 30.A.2 Packet Pg. 808 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 67 of 115 The cost of dental services and other medical services in 2018A was the highest for the United States, followed by Collier County, then by Florida. However, the cost of eyecare services in 2018A was the highest for Collier County, followed by the United States, then by Florida. TABLE 59 Healthcare Services and Other Services 2018A Statistics and 2023 Estimates 2018A 2023 Collier County Dental Services $252.65 $ 303.97 Eyecare Services $ 46.46 $ 56.00 Other Medical Services $ 10.49 $ 12.23 Physician Services $136.34 $ 151.88 Convalescent/Nursing Home Care $ 31.05 $ 33.99 Lab Tests and X-Rays $ 43.70 $ 49.04 Rental of Medical Equipment $ 0.62 $ 0.72 Services by Non-Physician Professionals $ 76.67 $ 91.80 Florida Dental Services $222.99 $ 270.80 Eyecare Services $ 40.88 $ 50.02 Other Medical Services $ 10.48 $ 12.19 Physician Services $133.40 $ 149.52 Convalescent/Nursing Home Care $ 28.13 $ 31.91 Lab Tests and X-Rays $ 44.05 $ 50.08 Rental of Medical Equipment $ 0.52 $ 0.62 Services by Non-Physician Professionals $ 66.09 $ 79.58 United States Dental Services $305.92 $ 378.80 Eyecare Services $ 44.56 $ 55.35 Other Medical Services $ 13.97 $ 16.96 Physician Services $198.81 $ 234.86 Convalescent/Nursing Home Care $ 23.14 $ 26.81 Lab Tests and X-Rays $ 44.26 $ 51.67 Rental of Medical Equipment $ 0.46 $ 0.56 Services by Non-Physician Professionals $ 87.70 $ 108.39 Source: DemographicsNow. (2018). Collier County, FL, Florida and Entire US CEX - Healthcare Detail Comparison [Data]. Retrieved September 17, 2018 from DemographicsNow database. 30.A.2 Packet Pg. 809 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 68 of 115 The cost of drugs is the highest for Collier County, the State of Florida, and the United States, which is followed by healthcare supplies and equipment, and eyeglasses and contact lenses in 2018A. In 2023, it is estimated for the costs to increase. TABLE 60 Healthcare Supplies and Equipment 2018A Statistics and 2023 Estimates 2018A 2023 Collier County Eyeglasses And Contact Lenses $ 68.94 $ 84.08 Healthcare Supplies and Equipment $ 158.58 $ 193.73 Drugs $ 467.45 $ 537.88 Florida Eyeglasses And Contact Lenses $ 56.93 $ 69.48 Healthcare Supplies and Equipment $ 129.72 $ 159.55 Drugs $ 441.41 $ 510.99 United States Eyeglasses And Contact Lenses $ 72.07 $ 89.54 Healthcare Supplies and Equipment $ 149.74 $ 189.78 Drugs $ 457.12 $ 551.02 Source: DemographicsNow. (2018). Collier County, FL, Florida and Entire US CEX - Healthcare Detail Comparison [Data]. Retrieved September 17, 2018 from DemographicsNow database. 30.A.2 Packet Pg. 810 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 69 of 115 Collier County reported a below state rate for selected vaccine-preventable diseases, with the exception of the years 2008, 2011, 2013, 2014, and 2016. Please note, data was not available for 2015. GRAPH 30 Selected Vaccine-Preventable Disease Rate for All Ages Source: Florida Department of Health. (2018). Communicable Diseases: Selected Vaccine Preventable Disease Rate for All Ages. Retrieved from http://flhealthcharts.org 2007 2008 2009 2010 2011 2012 2013 2014 2016 Collier 2.5 4.4 2.5 2.8 6.5 3.4 6.5 6.8 6.8 Florida 3.3 3.7 4.5 3.5 3.0 4.6 5.8 5.8 5.3 0 1 2 3 4 5 6 7 8 Rate Per 100,000Selected Vaccine-Preventable Disease Rate for All Ages 30.A.2 Packet Pg. 811 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 70 of 115 Collier County has seen an increase of preventable hospitalizations from vaccine-preventable conditions per 100,000 people under 65 years of age. *Data was not available for Collier County in 2008-2011, 2014, and 2016-2017. GRAPH 31 Preventable Hospitalizations under 65 from Vaccine-Preventable Conditions Source: Florida Department of Health. (2018). Communicable Diseases: Preventable Hospitalizations under 65 from Vaccine Preventable Conditions. Retrieved from http://flhealthcharts.org 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Collier 0 0 0 0 2.1 2 0 2 0 0 Florida 0.9 0.9 0.8 0.7 1.1 1.1 1.0 0.5 0.5 0.5 0 0.5 1 1.5 2 2.5 Rate Per 100,00030.A.2 Packet Pg. 812 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 71 of 115 From 2011 to 2017, Collier County has consistently had a much lower HIV/AIDS rate per 100,000 than the State of Florida. The HIV rate per 100,000 in Collier County was high in 2016. In the State of Florida, the HIV rate per 100,000 was high in 2011. The AIDS rate per 100,000 in Collier County was high in 2012-2013. In the State of Florida, the AIDS rate per 100,000 was high in 2011. TABLE 61 HIV/AIDS Rate per 100,000 2011 2012 2013 2014 2015 2016 2017 Collier County HIV Cases Rate 12.9 11.0 10.4 9.4 14.5 17.6 13.4 AIDS Cases Rate 7.1 8.6 8.6 5.0 5.8 7.1 7.5 HIV/AIDS Age Adjusted Death Rate 1.3 0.7 2.3 0.9 0.6 1.7 1.7 Florida HIV Cases Rate 24.7 23.6 22.6 23.5 24.5 24.6 24.1 AIDS Cases Rate 16.0 15.0 15.2 11.7 11.2 10.5 9.9 HIV/AIDS Age Adjusted Death Rate 5.1 4.6 4.5 4.2 4.0 3.9 3.2 Source: Florida Department of Health. (2018). Communicable Diseases: AIDS Cases; HIV Cases; Deaths from HIV/AIDS. Retrieved from http://flhealthcharts.org GRAPH 32 HIV/AIDS Age Adjusted Death Rate Source: Florida Department of Health. (2018). Communicable Diseases: AIDS Cases; HIV Cases; Deaths from HIV/AIDS. Retrieved from http://flhealthcharts.org 0 1 2 3 4 5 6 2011 2012 2013 2014 2015 2016 2017Rate Per 100,000HIV/ AIDS Age Adjusted Death Rate Collier County Florida 30.A.2 Packet Pg. 813 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 72 of 115 From 2010 to 2015, Collier County has consistently had a much lower total gonorrhea, chlamydia and infectious syphilis rate per 100,000 than the State of Florida. The total gonorrhea, chlamydia and infectious syphilis rate per 100,000 was highest during 2015 for Collier County and the State of Florida. TABLE 62 Total Gonorrhea, Chlamydia & Infectious Syphilis Rate per 100,000 2010 2011 2012 2013 2014 2015 Collier County 232.0 249.4 275.5 262.0 261.4 290.1 Florida 510.4 511.9 518.7 536.1 539.5 588.7 Source: Florida Department of Health. (2018). Communicable Diseases: Sexually Transmitted Diseases: Total Gonorrhea, Chlamydia & Infectious Syphilis. Retrieved from http://flhealthcharts.org GRAPH 33 Total Gonorrhea, Chlamydia & Infectious Syphilis Rate Source: Florida Department of Health. (2018). Communicable Diseases: Sexually Transmitted Diseases: Total Gonorrhea, Chlamydia & Infectious Syphilis. Retrieved from http://flhealthcharts.org The total number of people who visited the ER in which the patient was uninsured/underinsured in Collier County was highest in 2014 – 2015. TABLE 63 Total Number of ER Visits in which the Patient was Uninsured/Underinsured in Collier County 2014 2015 2016 2017 2018 Collier County 15,778 15,364 14,523 14,523 11,971 Source: Health Planning Council of Southwest Florida. (2018). 2018 Collier County Florida Health Profile. Retrieved from http://www.hpcswf.com 200 250 300 350 400 450 500 550 600 2010 2011 2012 2013 2014 2015Rate Per 100,000Total Gonorrhea, Chlamydia & Infectious Syphilis Rate Collier County Florida 30.A.2 Packet Pg. 814 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 73 of 115 Middle and High School Student Risk Factors From 2010 to 2013, the percent of Collier County elementary and middle school students at risk for being overweight has been 18-19 percent. This trend has been constant during this time period. TABLE 64 Percent of Collier County Elementary and Middle School Students at Risk for Being Overweight 2010-2011 2011-2012 2012-2013 Collier County 18% 19% 18% Source: NCH Safe & Healthy Children’s Coalition. (2018). NCH Safe & Healthy Children’s Coalition 2013 Annual Report. Retrieved from http://www.safehealthychildren.org From 2010 to 2013, the percent of Collier County elementary and middle school students in the obese range has slightly fluctuated, ranging from 22 to 24 percent. TABLE 65 Percent of Collier County Elementary and Middle School Students in the Obese Range 2010-2011 2011-2012 2012- 2013 Collier County 23% 24% 22% Source: NCH Safe & Healthy Children’s Coalition. (2018). NCH Safe & Healthy Children’s Coalition 2013 Annual Report. Retrieved from http://www.safehealthychildren.org GRAPH 34 Collier County Elementary and Middle School Student Weight Risk Source: NCH Safe & Healthy Children’s Coalition. (2018). NCH Safe & Healthy Children’s Coalition 2013 Annual Report. Retrieved from http://www.safehealthychildren.org 0% 5% 10% 15% 20% 25% 30% 2010-2011 2011-2012 2012-2013PercentCollier County Elementary and Middle School Student Weight Risk At Risk For Being Overweight In Obese Range 30.A.2 Packet Pg. 815 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 74 of 115 In the State of Florida, the percentage of surveyed youth in middle school and high school who reported gang membership declined from 2010 to 2016; however, in 2018, the percentage of students reporting gang membership in middle school increased by 0.5 percent and in high school increased by 0.2 percent. Collier County data from 2008 to 2012 and 2018 was not available. TABLE 66 Percentage of Collier County and Florida Statewide Youth in Middle School and High School Who Reported Gang Membership–2008 to 2018 2008 2010 2012 2014 2016 2018 Collier County Middle School - - - 2.70% 2.70% - High School - - - 4.40% 1.90% - Florida Middle School 7.50% 5.90% 4.30% 3.60% 3.30% 3.80% High School 6.60% 5.30% 4.20% 3.70% 3.50% 3.70% Source: Florida Department of Children & Families. (2018). 2018 Florida Youth Substance Abuse Survey Collier County Data Tables. Retrieved from http://www.dcf.state.fl.us In Collier County and the State of Florida, the percentage of surveyed youth in middle school and high school who reported alcohol use in the past 30 days declined from 2008 to 2016. Data for Collier County was not available for 2018. TABLE 67 Percentage of Surveyed Collier County and Florida Youth Who Reported Alcohol Use in the Past 30 Days 2008 2010 2012 2014 2016 2018 Collier Middle School 13.70% 13.90% 14.80% 7.30% 7.30% - High School 44.60% 41.70% 36.40% 29.60% 29.40% - Florida Middle School 17.30% 16.80% 12.30% 10.10% 8.00% 7.30% High School 39.50% 38.00% 33.90% 28.40% 25.50% 21.20% Source: Florida Department of Children & Families. (2018). 2018 Florida Youth Substance Abuse Survey Collier County Data Tables. Retrieved from http://www.dcf.state.fl.us 30.A.2 Packet Pg. 816 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 75 of 115 From 2008 to 2018, Collier County and the State of Florida middle school students and high school students were asked if they skipped school because of bullying; 2.60-8.40 percent of them indicated that it had. Data for Collier County was not available for 2018. TABLE 68 Percentages of Collier County and Florida Youth Who Reported They Skipped School Because of Bullying 2008 2010 2012 2014 2016 2018 Collier Middle School 2.60% 3.30% 4.70% 8.10% 6.30% - High School - 2.60% 3.60% 6.60% 6.90% - Florida Middle School 2.90% 3.70% 4.40% 5.60% 7.60% 7.70% High School - 3.90% 4.50% 6.20% 8.20% 8.40% Source: Florida Department of Children & Families. (2018). 2018 Florida Youth Substance Abuse Survey Collier County Data Tables. Retrieved from http://www.dcf.state.fl.us 30.A.2 Packet Pg. 817 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 76 of 115 Adults with Health-Related Difficulties From 2012 to 2017, males and females that were 5-17 years of age experienced the lowest percentage of ambulatory difficulty. Females 75 years and over experienced the highest percentage of ambulatory difficulty. TABLE 69 Percent of Residents with Ambulatory Difficulty 2012 2013 2014 2015 2016 2017 Collier Male 5 to 17 years 0.52% 2.48% 0.24% 1.81% 0.77% 0.29% Male 18 to 34 years 0.43% 1.14% 1.22% 1.67% 0.00% 0.47% Male 35 to 64 years 5.89% 6.83% 4.22% 5.69% 2.84% 4.33% Male 65 to 74 years 7.48% 5.02% 7.63% 7.30% 6.93% 7.52% Male 75 years and over 14.23% 14.92% 17.59% 10.62% 18.48% 16.01% Female 5 to 17 years 1.05% 0.30% 0.00% 0.45% 0.00% 0.57% Female 18 to 34 years 0.28% 2.14% 0.35% 0.57% 0.81% 2.18% Female 35 to 64 years 4.55% 5.06% 3.35% 2.95% 4.26% 4.51% Female 65 to 74 years 5.98% 10.13% 8.50% 4.07% 6.54% 8.95% Female 75 years and over 28.44% 23.48% 18.38% 24.13% 20.28% 27.14% Florida Male 5 to 17 years 0.57% 0.73% 0.58% 0.61% 0.58% 0.77% Male 18 to 34 years 1.46% 1.38% 1.44% 1.31% 1.53% 1.57% Male 35 to 64 years 7.00% 7.09% 7.06% 6.75% 6.82% 6.86% Male 65 to 74 years 12.63% 12.68% 12.61% 12.73% 12.20% 13.19% Male 75 years and over 24.95% 26.23% 25.27% 26.16% 26.29% 24.76% Female 5 to 17 years 0.67% 0.56% 0.56% 0.59% 0.56% 0.63% Female 18 to 34 years 1.42% 1.51% 1.23% 1.33% 1.39% 1.18% Female 35 to 64 years 7.65% 7.92% 7.55% 7.49% 7.58% 7.36% Female 65 to 74 years 14.96% 15.25% 15.33% 14.75% 14.74% 14.24% Female 75 years and over 33.67% 34.75% 34.79% 34.35% 33.50% 33.64% United States Male 5 to 17 years 0.69% 0.67% 0.67% 0.67% 0.67% 0.64% Male 18 to 34 years 1.42% 1.42% 1.40% 1.37% 1.42% 1.38% Male 35 to 64 years 6.75% 6.89% 6.84% 6.74% 6.70% 6.49% Male 65 to 74 years 13.67% 13.93% 14.71% 13.91% 13.75% 13.71% Male 75 years and over 27.52% 28.04% 27.50% 27.33% 27.46% 26.90% Female 5 to 17 years 0.59% 0.59% 0.60% 0.58% 0.58% 0.57% Female 18 to 34 years 1.42% 1.44% 1.43% 1.38% 1.38% 1.30% Female 35 to 64 years 7.97% 8.10% 8.13% 7.97% 7.98% 7.58% Female 65 to 74 years 17.43% 17.47% 17.30% 16.93% 16.92% 16.45% Female 75 years and over 36.52% 37.05% 36.92% 36.40% 36.26% 35.36% Source: Source: U.S. Census Bureau. (2018). 2017 American Community Survey 1-year estimates: Table B18105. Retrieved from http://www.census.gov/ 30.A.2 Packet Pg. 818 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 77 of 115 From 2012 to 2017, in Collier County, the State of Florida, and the United States, the male and female population percentages with self-care difficulty were highest for ages 75 and older. TABLE 70 Percent of Residents with Self-Care Difficulty 2012 2013 2014 2015 2016 2017 Collier Male 5 to 17 years 0.67% 2.95% 1.01% 2.37% 0.58% 0.78% Male 18 to 34 years 0.43% 0.00% 0.84% 0.40% 0.29% 0.32% Male 35 to 64 years 1.14% 1.69% 2.42% 0.37% 1.40% 0.96% Male 65 to 74 years 4.10% 1.32% 3.44% 1.20% 1.72% 2.50% Male 75 years and over 4.23% 5.79% 9.69% 1.47% 8.66% 8.32% Female 5 to 17 years 0.00% 0.30% 0.66% 1.08% 0.00% 0.00% Female 18 to 34 years 0.44% 1.47% 0.67% 0.19% 0.40% 0.29% Female 35 to 64 years 0.87% 2.02% 2.47% 1.00% 1.09% 0.72% Female 65 to 74 years 1.30% 2.32% 3.95% 0.78% 3.09% 1.05% Female 75 years and over 10.15% 12.65% 15.20% 5.98% 12.70% 5.71% Florida Male 5 to 17 years 1.06% 1.08% 1.01% 1.14% 1.15% 1.18% Male 18 to 34 years 0.96% 0.87% 0.84% 0.89% 1.02% 1.23% Male 35 to 64 years 2.55% 2.38% 2.42% 2.29% 2.31% 2.37% Male 65 to 74 years 3.91% 3.45% 3.44% 3.73% 3.22% 3.62% Male 75 years and over 9.16% 9.38% 9.69% 9.62% 9.69% 9.80% Female 5 to 17 years 0.75% 0.76% 0.66% 0.72% 0.69% 0.78% Female 18 to 34 years 0.71% 0.94% 0.67% 0.64% 0.91% 0.68% Female 35 to 64 years 2.54% 2.44% 2.47% 2.36% 2.39% 2.55% Female 65 to 74 years 3.84% 3.66% 3.95% 3.67% 3.60% 3.31% Female 75 years and over 14.81% 14.35% 15.20% 14.47% 13.89% 13.94% United States Male 5 to 17 years 1.17% 1.10% 1.16% 1.15% 1.25% 1.21% Male 18 to 34 years 0.91% 0.90% 0.91% 0.93% 0.99% 0.98% Male 35 to 64 years 2.36% 2.36% 2.37% 2.38% 2.34% 2.26% Male 65 to 74 years 4.28% 4.16% 4.22% 4.20% 4.21% 4.04% Male 75 years and over 11.11% 10.94% 11.09% 10.84% 10.98% 10.65% Female 5 to 17 years 0.74% 0.69% 0.74% 0.73% 0.79% 0.74% Female 18 to 34 years 0.75% 0.76% 0.77% 0.74% 0.78% 0.75% Female 35 to 64 years 2.56% 2.58% 2.57% 2.55% 2.53% 2.42% Female 65 to 74 years 4.96% 4.77% 4.73% 4.62% 4.51% 4.33% Female 75 years and over 15.88% 16.02% 15.84% 15.59% 15.47% 14.97% Source: U.S. Census Bureau. (2018). 2017 American Community Survey 1-year Estimate: Table B18106. Retrieved from http://www.census.gov/ 30.A.2 Packet Pg. 819 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 78 of 115 From 2012 to 2017, in Collier County, the State of Florida, and the United States, the male and female population percentages with independent living difficulty were highest for ages 75 and older. TABLE 71 Percent of Residents with Independent Living Difficulty 2012 2013 2014 2015 2016 2017 Collier Male 18 to 34 years 1.11% 2.05% 0.81% 2.05% 2.77% 0.94% Male 35 to 64 years 3.85% 2.94% 2.34% 1.47% 4.15% 0.74% Male 65 to 74 years 5.48% 2.86% 5.39% 3.64% 6.54% 3.43% Male 75 years and over 10.01% 13.60% 11.69% 5.81% 18.68% 9.89% Female 18 to 34 years 1.12% 2.69% 2.02% 1.57% 2.21% 2.79% Female 35 to 64 years 3.74% 2.87% 1.55% 1.80% 4.89% 1.94% Female 65 to 74 years 3.01% 3.93% 4.56% 3.32% 8.49% 2.86% Female 75 years and over 27.65% 20.14% 15.87% 17.28% 29.10% 16.38% Florida Male 18 to 34 years 2.49% 2.44% 2.76% 2.43% 2.96% 2.95% Male 35 to 64 years 4.29% 4.16% 4.22% 4.20% 4.17% 4.01% Male 65 to 74 years 6.23% 5.59% 5.75% 5.32% 5.07% 5.64% Male 75 years and over 17.16% 17.00% 16.84% 16.80% 16.87% 16.33% Female 18 to 34 years 1.94% 2.03% 1.92% 1.71% 2.14% 2.20% Female 35 to 64 years 4.74% 4.65% 4.81% 4.65% 4.62% 4.49% Female 65 to 74 years 7.54% 6.69% 7.24% 7.18% 6.98% 6.48% Female 75 years and over 27.28% 27.12% 27.49% 27.44% 25.89% 25.75% United States Male 18 to 34 years 2.35% 2.43% 2.50% 2.57% 1.50% 2.77% Male 35 to 64 years 4.08% 4.12% 4.12% 4.16% 2.78% 4.02% Male 65 to 74 years 6.77% 6.69% 6.71% 6.54% 2.60% 6.51% Male 75 years and over 19.36% 19.15% 19.03% 18.91% 9.24% 18.02% Female 18 to 34 years 1.92% 1.95% 2.06% 2.06% 0.79% 2.28% Female 35 to 64 years 4.85% 4.87% 4.94% 4.88% 2.54% 4.70% Female 65 to 74 years 9.29% 8.83% 8.85% 8.62% 4.74% 8.33% Female 75 years and over 30.43% 30.25% 30.03% 29.58% 18.77% 28.21% Source: U.S. Census Bureau. (2018). 2017 American Community Survey 1-year Estimates: Table B18107. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 820 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 79 of 115 Education The School District of Collier County has a total of 48 schools (29 elementary schools, ten middle schools, eight high schools, one Pre-K-thru-12 school). These schools serve a total student body of 48,000 students. There are also 13 Alternative School Programs. In addition, the district has two technical colleges and adult education programs. From 2011 to 2018 in the School District of Collier County student body, students who were white, black, and Hispanic made up the largest percentages. The Hispanic population dominates the highest percentage of students in Collier County schools. TABLE 72 School District of Collier County Demographics - All Grades 2011 2012 2013 2014 2015 2016 2017 2018 White 40% 39% 38% 37% 36% 36% 34% 33% 17,174 16,960 16, 701 15,420 16,487 16,386 16,712 16,013 Black 12% 12% 12% 12% 12% 12% 11% 12% 5,181 5,203 5,308 5,418 5,416 5,334 5,637 5,524 Hispanic 44% 44% 46% 47% 48% 49% 49% 51% 18,682 19,205 19,966 20,786 21,510 22,420 24,412 24,079 Multi 2% 2% 2% 2% 2% 2% 3% 2% 851 897 914 878 904 904 1511 977 Asian 1% 1% 1% 1% 1% 1% 1% 1% 464 478 470 493 522 575 647 710 Pacific Islander 1% 1% 1% 1% 1% 1% 1% 0% 50 42 41 48 51 43 47 0 Source: Collier County Public Schools (2018). District Profile: Demographics by race -- grade all - district. Retrieved from http://collierschools.com 30.A.2 Packet Pg. 821 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 80 of 115 GRAPH 35 2018 School District of Collier County Demographics Source: Collier County Public Schools (2018). District Profile: Demographics by race -- grade all - district. Retrieved from http://collierschools.com From 2009 to 2016 in Collier County, the percentages of KG-5, Grades 6-8, and Grades 9-12 needing a free and reduced lunch have increased. TABLE 73 Free and Reduced Lunch by Grade Level 2009 2010 2011 2012 2013 2014 2015 2016 KG - 5 58% 61% 65% 66% 67% 67% 66% 66% 11,210 11,888 12,855 13,159 13,556 13,771 13,828 13,826 Grades 6 - 8 51% 53% 59% 59% 61% 60% 61% 61% 4,862 5,027 5,608 5,642 5,944 6,059 6,432 6,485 Grades 9-12 38% 42% 47% 49% 51% 53% 53% 54% 4,798 5,261 5,974 6,244 6,600 6,815 6,924 7,329 Source: Collier County Public Schools (2017). District Profile: Demographics by free and reduced lunch- combined grades - district. Retrieved from http://collierschools.com 33% 12% 51% 2%1%0% 2018 School District of Collier County Demographics White Black Hispanic Multi Asian Pac Islander 30.A.2 Packet Pg. 822 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 81 of 115 GRAPH 36 Free and Reduced Lunch Source: Collier County Public Schools (2017). District Profile: Demographics by free and reduced lunch- combined grades - district. Retrieved from http://collierschools.com The Florida Department of Education has created various domain codes that are utilized to indicate which students are considered Limited English Proficient (LEP) and their standing regarding having enrolled in a course that has been created for LEP students. Students that have been assigned the code of “LY” were identified as being Limited English Proficient and are currently enrolled in courses created for LEP students. Students that have been assigned the code “LN” have been identified as LEP students but have not enrolled in courses created for LEP students. Students that have been assigned the code “LF” have attended an ESOL program and are being monitored for two years. Students that have been assigned the code “LP” are in grades 4-12 and have various indicators that indicate that they should receive an aural/oral assessment to measure their English proficiency levels. Students that have the code “LZ” assigned to them have been identified as an LEP student, have exited the ESOL program, and are no longer being monitored. In the School District of Collier County, students who are in KG-5 are the highest percentage of students who are considered “LY” students. The percentage of students who have been coded as “LY” students has gradually trended upward from 2009-2014; however, trended downward from 2014-2016. 30% 35% 40% 45% 50% 55% 60% 65% 70% 2009 2010 2011 2012 2013 2014 2015 2016 Free and Reduced Lunch KG - 5 Grades 6 - 8 Grades 9-12 30.A.2 Packet Pg. 823 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 82 of 115 TABLE 74 Limited English Proficiency (LEP)-School District of Collier County 2009 2010 2011 2012 2013 2014 2015 2016 KG - 5 LY 21% 21% 20% 21% 22% 23% 22% 22% LN 0% 0% 0% 0% 0% 0% 0% 0% LF 5% 3% 7% 8% 6% 7% 8% 8% LP 0% 0% 0% 0% 0% 0% 0% 0% LZ 5% 5% 4% 2% 3% 3% 3% 4% Non-LEP 69% 71% 69% 69% 69% 67% 67% 65% Grades 6 - 8 LY 7% 8% 6% 5% 6% 6% 5% 5% LN 0% 0% 0% 0% 0% 0% 0% 0% LF 7% 5% 7% 7% 5% 5% 7% 6% LP 0% 0% 0% 0% 0% 0% 0% 0% LZ 18% 20% 19% 19% 21% 21% 20% 18% Non-LEP 67% 67% 68% 68% 68% 68% 68% 70% Grades 9 - 12 LY 9% 8% 7% 6% 6% 5% 5% 5% LN 0% 0% 0% 0% 0% 0% 0% 0% LF 3% 2% 3% 4% 2% 3% 3% 3% LP 0% 0% 0% 0% 0% 0% 0% 0% LZ 17% 20% 22% 23% 25% 25% 24% 24% Non-LEP 71% 70% 68% 68% 67% 67% 68% 68% Source: Collier County Public Schools (2017). District Profile: LEP Status-Combined Grades. Retrieved from http://collierschools.com LY = Limited English Proficient (LEP), currently enrolled in LEP course LN = Identified as LEP students but have not enrolled in LEP courses LF = Student attended an English second language (ESOL) program and are being monitored for two years LP = 4th-12th grade, various indicators for need to measure English proficiency levels. LZ = LEP students, completed ESOL program, no longer monitored 30.A.2 Packet Pg. 824 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 83 of 115 Estimates from 2017 indicate that Collier County has a higher percentage of its residents who speak in a different language at home (33.2%) than in the State of Florida (29.7%) and the United States (21.8%). TABLE 75 Language Spoken at Home (2017 Estimate) Collier County Florida United States Population 5 years and over 356,026 19,855,078 305,924,019 English only 66.8% 70.3% 78.2% Language other than English 33.2% 29.7% 21.8% Speak English less than "very well" 15.8% 12.2% 8.5% Spanish 24.6% 21.8% 13.4% Speak English less than "very well" 12.4% 9.4% 5.4% Other Indo-European languages 7.5% 5.5% 3.7% Speak English less than "very well" 3.1% 1.9% 1.1% Asian and Pacific Islander languages 0.9% 1.7% 3.5% Speak English less than "very well" 0.2% 0.7% 1.6% Other languages 0.2% 0.7% 1.1% Speak English less than "very well" 0.0% 0.2% 0.3% Source: Census Bureau. (2018). 2017 American Community Survey. Table CP02. Retrieved from http://factfinder.census.gov From 2013 to 2016, in Collier County, the State of Florida and the United States, the percentage of students who were ACT test takers gradually increased; however, in 2017, Collier County, the State of Florida, and the United States percentage decreased. TABLE 76 ACT Test Takers and Participation Rate (Public Schools) 2013 2014 2015 2016 2017 Collier County n 1,998 1,987 2,008 2,234 2,454 % 72% 74% 74% 78% 76% Florida n 124,131 129,676 130,798 131,621 129,320 % 74% 81% 79% 81% 73% United States n 1,799,234 1,845,787 1,924,436 2,090,342 2,030,038 % 34% 57% 59% 64% 63% Source: Collier County Public Schools. (2018). 2016-2017 ACT Assessment Results Memorandum. Retrieved from http://collierschools.com 30.A.2 Packet Pg. 825 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 84 of 115 From 2013 to 2017, the ACT average scores were relatively stable in Collier County, the State of Florida and the United States. Collier County and the State of Florida’s ACT average score were very close to each other, and the average ACT score for the United States tended to be slightly higher than that of Collier County and the State of Florida. TABLE 77 ACT Average Scores (Public Schools) 2013 2014 2015 2016 2017 Composite Scores Collier County 19.8 19.6 20.1 20.2 19.8 Florida 19.6 19.6 19.9 19.9 19.8 United States 20.9 21.0 21.0 20.8 21.0 English Scores Collier County 18.8 18.7 19.3 19.4 19.0 Florida 18.7 18.7 18.9 18.9 19.0 United States 20.2 20.3 20.4 20.1 20.3 Mathematics Scores Collier County 19.9 19.5 19.8 19.7 19.3 Florida 19.7 19.5 19.6 19.5 19.4 United States 20.9 20.9 20.8 20.6 20.7 Reading Scores Collier County 20.4 20.5 21.0 21.2 20.9 Florida 20.4 20.7 21.0 21.1 21.0 United States 21.1 21.3 21.4 21.3 21.4 Science Scores Collier County 19.5 19.3 19.9 19.9 19.4 Florida 19.1 19.1 19.5 19.5 19.4 United States 20.7 20.8 20.9 20.8 21.0 Source: Collier County Public Schools. (2018). 2016-2017 ACT Assessment Results Memorandum. Retrieved from http://collierschools.com From 2012 to 2016 in Collier County, the ACT composite scores and participation by race were measured. Collier County’s white student population had the highest ACT composite scores, followed by the Hispanic student population and the black student population. TABLE 78 Collier County ACT Composite Scores and Participation by Race (Public Schools) 2012 2013 2014 2015 2016 Composite Scores Black 16.3 16.4 16.4 17.2 16.9 White 22.7 22.4 22.2 22.6 22.8 Hispanic 18.3 18.2 18.1 18.5 18.6 Number of Students Black 223 295 238 298 269 White 769 805 752 792 847 Hispanic 629 721 816 814 933 Source: Collier County Public Schools. (2018). 2015-2016 ACT Assessment Results Memorandum. Retrieved from http://collierschools.com 30.A.2 Packet Pg. 826 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 85 of 115 From 2015 to 2018, the percent of students scoring three or above in English Language Arts (ELA) was consistently similar for Collier County and the State of Florida. TABLE 79 FSA English Language Arts Scores - Percent of Students Scoring Three or Above (Public Schools) 2015 2016 2017 2018 Grade 3 Collier County 53% 52% 57% 59% Florida 53% 54% 58% 57% Grade 4 Collier County 52% 53% 57% 60% Florida 54% 52% 56% 56% Grade 5 Collier County 52% 51% 56% 59% Florida 52% 52% 53% 55% Grade 6 Collier County 50% 54% 55% 56% Florida 51% 52% 52% 52% Grade 7 Collier County 55% 51% 57% 54% Florida 51% 49% 52% 51% Grade 8 Collier County 61% 65% 58% 63% Florida 55% 57% 55% 58% Grade 9 Collier County 57% 58% 58% 56% Florida 53% 51% 52% 53% Grade 10 Collier County 55% 55% 55% 59% Florida 51% 50% 50% 53% Source: Collier County Public Schools. (2018). 2017-2018 State FSA and ECO Exam Results for Grades 3-10. Retrieved from http://collierschools.com The SAT five-year trend of participation rates for Collier County was highest in 2013 and 2017; however, from 2014 to 2016, the trend of participation rates for Collier County fluctuated. TABLE 80 SAT Five-Year Trend of Participation Rates (Public Schools) 2013 2014 2015 2016 2017 Collier County n 1,620 1,416 1,535 1,427 1,854 % 58% 55% 55% 50% 56% Florida n 112,554 115,437 122,939 122,294 134,808 % 67% 72% 74% 63% 64% United States n 1,660,047 1,672,395 1,698,521 1,637,589 1,832,683 % 50% 52% 52% 47% 48% Source: Collier County Public Schools. (2018). 2016-2017 SAT Assessment Results Memorandum. Retrieved from http://collierschools.com 30.A.2 Packet Pg. 827 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 86 of 115 From 2013 to 2016, the SAT critical reading, writing, and math mean score for students from Collier County, the State of Florida, and the United States has fluctuated. * 2017 is the first year the redesigned SAT is reported. Critical Reading and Writing were combined. TABLE 81 SAT Critical Reading, Writing and Math Mean Score Comparison 2013 2014 2015 2016 2017* Collier County Critical Reading 490 499 498 508 533 Writing 477 480 482 488 Math 493 494 493 501 507 Florida Critical Reading 492 491 486 481 517 Writing 475 472 468 462 Math 490 485 480 475 493 United States Critical Reading 496 497 495 494 538 Writing 488 487 484 482 Math 514 513 511 508 533 Source: Collier County Public Schools. (2018). 2016-2017 SAT Assessment Results Memorandum. Retrieved from http://collierschools.com From 2011 to 2015, the five-year trend for college-bound senior SAT test takers participation rate by ethnicity experienced an upward trend for all groups. The highest percentage of SAT-takers was white students, followed by Hispanic students and black students. TABLE 82 Collier County Five-Year Trend for College-Bound Senior SAT Test Takers: Mean Scores and Participation Rate by Ethnicity 2011 2012 2013 2014 2015 White Students Number 893 888 880 794 758 Participation Rate 65% 67% 67% 66% 61% Critical Reading Mean 510 519 520 519 526 Writing Mean 494 500 508 502 510 Math Mean 521 525 528 516 524 Hispanic Students Number 392 450 483 416 490 Participation Rate 40% 52% 48% 40% 45% Critical Reading Mean 462 460 466 472 472 Writing Mean 450 445 453 452 460 Math Mean 468 468 467 465 466 Black Students Number 139 125 136 105 170 Participation Rate 40% 43% 38% 34% 46% Critical Reading Mean 410 426 418 432 441 Writing Mean 389 413 405 412 414 Math Mean 407 422 410 410 414 Source: Collier County Public Schools. (2018). 2014-2015 SAT Assessment Results Memorandum. Retrieved from http://collierschools.com 30.A.2 Packet Pg. 828 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 87 of 115 TABLE 83 Mean SAT Scores Public and Independent School Comparison Schools Critical Reading Mathematics Writing 2016 Florida Public 474 467 454 Religious 522 520 516 Independent 540 560 539 United States Public 487 494 472 Religious 532 537 525 Independent 530 579 536 2015 Florida Public 481 474 461 Religious 520 516 513 Independent 538 555 535 United States Public 489 498 475 Religious 533 536 527 Independent 532 579 538 2014 Florida Public 486 479 465 Religious 519 515 510 Independent 535 556 534 United States Public 492 501 478 Religious 533 537 527 Independent 535 580 542 2013 Florida Public 488 486 469 Religious 519 516 513 Independent 529 552 529 United States Public 491 503 480 Religious 531 536 528 Independent 536 581 545 Source: The College Board. (2018). 2016 SAT Report on College-Bound seniors. Retrieved from: www.collegeboard.org 30.A.2 Packet Pg. 829 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 88 of 115 From 2012 to 2017, the high school graduation rates for Collier County and the State of Florida increased. TABLE 84 High School Graduation Rates, Florida's Calculation 2012-13 2013-14 2014-15 2015-16 2016-17 Collier County 81.3% 82.1% 84.3% 86.7% 88.2% Florida 75.6% 76.1% 77.9% 80.7% 82.3% United States 81.0% 82.3% 83.2% 84.1% - Source: Florida Department of Education. (2018) 2016-17 Florida’s High School Cohort Graduation Rate. Retrieved from: http://www.fldoe.org; National Center for Education Statistics, Common Core of Data (CCD). (2018) 2015-16 Dropout and Completer Data Tables. Retrieved from: https://nces.ed.gov GRAPH 37 High School Graduation Rate Source: Florida Department of Education. (2018) 2016-17 Florida’s High School Cohort Graduation Rate. Retrieved from: http://www.fldoe.org; National Center for Education Statistics, Common Core of Data (CCD). (2018) 2015-16 Dropout and Completer Data Tables. Retrieved from: https://nces.ed.gov 60.0% 65.0% 70.0% 75.0% 80.0% 85.0% 90.0% 2012-13 2013-14 2014-15 2015-16 2016-17 High School Graduation Rates Collier County Florida United States 30.A.2 Packet Pg. 830 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 89 of 115 School enrollment has been fluctuating since 2013-2017 in Collier County, the State of Florida, and the United States. TABLE 85 School Enrollment 2013 2014 2015 2016 2017 Collier County Population 3 years and over enrolled in school 64,171 63,871 67,853 65,401 64,930 Nursery school, preschool 6.2% 3.8% 6.0% 5.0% 4.1% Kindergarten 4.8% 4.5% 5.4% 5.4% 4.4% Elementary school (grades 1-8) 43.9% 45.9% 42.5% 43.5% 47.3% High school (grades 9-12) 19.7% 24.9% 22.8% 23.5% 21.0% College or graduate school 25.5% 20.9% 23.4% 22.5% 23.2% Florida Population 3 years and over enrolled in school 4,643,948 4,674,255 4,706,933 4,718,808 4,770,596 Nursery school, preschool 6.2% 6.0% 6.1% 6.0% 6.1% Kindergarten 4.9% 4.8% 4.7% 4.9% 4.8% Elementary school (grades 1-8) 39.0% 39.2% 39.0% 39.1% 39.6% High school (grades 9-12) 20.6% 20.9% 20.9% 21.0% 20.8% College or graduate school 29.3% 29.1% 29.1% 29.0% 28.8% United States Population 3 years and over enrolled in school 2,395,254 82,063,714 81,618,288 81,572,277 81,273,337 Nursery school, preschool 6.0% 6.0% 6.0% 6.0% 6.0% Kindergarten 5.2% 5.1% 5.0% 5.0% 4.9% Elementary school (grades 1-8) 40.0% 40.2% 40.3% 40.3% 40.5% High school (grades 9-12) 20.6% 20.7% 20.9% 21.0% 21.1% College or graduate school 28.3% 28.0% 27.8% 27.7% 27.4% Source: Census Bureau (2018). 2017 American Community Survey 1-year estimate Table: CP02. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 831 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 90 of 115 From 2013 to 2017, the number of people who obtained either a graduate or professional degree has gradually increased for Collier County, the State of Florida, and the United States. TABLE 86 Educational Attainment 2013 2014 2015 2016 2017 Collier County Population 25 years and over 252,800 259,692 268,250 275,724 283,595 Less than 9th grade 6.9% 8.1% 6.3% 8.2% 7.2% 9th to 12th grade, no diploma 5.5% 7.1% 6.9% 6.7% 4.5% High school graduate (includes equivalency) 28.3% 25.3% 26.1% 25.9% 27.0% Some college, no degree 17.8% 18.2% 17.9% 17.3% 16.2% Associate degree 9.1% 6.5% 7.7% 7.9% 8.1% Bachelor's degree 17.6% 21.2% 21.4% 19.6% 22.4% Graduate or professional degree 14.8% 13.6% 13.8% 14.3% 14.6% Florida Population 25 years and over 13,726,996 14,041,196 14,394,281 14,703,671 15,020,177 Less than 9th grade 5.3% 5.2% 5.2% 5.2% 4.7% 9th to 12th grade, no diploma 7.9% 7.6% 7.2% 7.4% 6.9% High school graduate (includes equivalency) 29.5% 29.6% 29.2% 28.9% 28.8% Some college, no degree 20.7% 20.7% 20.4% 20.1% 19.9% Associate degree 9.5% 9.7% 9.6% 9.7% 10.0% Bachelor's degree 17.6% 17.4% 18.2% 18.2% 18.9% Graduate or professional degree 9.7% 9.8% 10.2% 10.4% 10.8% United States Population 25 years and over 210,910,615 213,725,624 216,447,163 218,475,480 221,250,083 Less than 9th grade 5.8% 5.6% 5.5% 5.4% 5.1% 9th to 12th grade, no diploma 7.6% 7.5% 7.3% 7.2% 6.9% High school graduate (includes equivalency) 27.8% 27.7% 27.6% 27.2% 27.1% Some college, no degree 21.1% 21.0% 20.7% 20.6% 20.4% Associate degree 8.1% 8.2% 8.2% 8.4% 8.5% Bachelor's degree 18.4% 18.7% 19.0% 19.3% 19.7% Graduate or professional degree 11.2% 11.4% 11.6% 11.9% 12.3% Source: Census Bureau (2018). 2017 American Community Survey 1-year estimate Table: CP02. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 832 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 91 of 115 From 2014 to 2017 in Collier County, the State of Florida, and the United States, the population of 25 years and over chose (highest to lowest) business, education and science, and related fields as their first major. TABLE 87 Collier County Detailed Field of Bachelor’s Degree for First Major for the Population 25 Tears and Over 2014 2015 2016 2017 Collier County Total 90,277 94,443 93,512 104,937 Science and Engineering Computers, Mathematics and Statistics 2,043 2,350 2,236 3,351 Biological, Agricultural and Environmental Sciences 4,785 5,377 5,091 5,273 Physical and Related Sciences 2,113 3,110 3,016 4,574 Psychology 3,327 4,315 3,721 4,342 Social Sciences 7,422 6,874 6,914 8,939 Engineering 5,447 7,461 7,286 7,077 Multidisciplinary Studies 471 378 402 419 Science and Engineering Related Fields 8,263 7,390 8,293 10,149 Business 21,124 23,752 23,054 25,218 Education 15,843 15,549 14,154 16,787 Arts, Humanities and Other Literature and Languages 4,819 4,112 5,000 4,229 Liberal Arts and History 5,370 3,350 4,524 4,971 Visual and Performing Arts 2,240 3,096 3,805 3,659 Communications 2,007 3,178 2,132 1,984 Other 5,003 4,151 3,884 3,965 Source: Census Bureau (2018). 2017 American Community Survey 1-year estimate Table: B15010. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 833 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 92 of 115 TABLE 88 Florida Detailed Field of Bachelor’s Degree for First Major for the Population 25 Years and Over 2014 2015 2016 2017 Florida Total 3,830,504 4,092,338 4,208,456 4,454,492 Science and Engineering Computers, Mathematics and Statistics 146,526 151,990 155,050 171,336 Biological, Agricultural and Environmental Sciences 184,611 197,129 209,207 222,540 Physical and Related Sciences 112,839 112,242 113,952 116,480 Psychology 175,474 197,723 187,936 205,853 Social Sciences 264,583 285,945 298,762 308,548 Engineering 293,646 318,838 331,390 358,356 Multidisciplinary Studies 26,769 19,826 25,404 29,646 Science and Engineering Related Fields 385,093 414,601 432,861 475,420 Business 936,865 995,869 1,002,581 1,084,019 Education 550,212 589,792 566,225 582,640 Arts, Humanities and Other Literature and Languages 118,586 133,919 150,060 145,364 Liberal Arts and History 163,744 177,220 185,286 185,733 Visual and Performing Arts 122,926 122,006 138,054 144,434 Communications 136,864 148,969 161,048 162,072 Other 211,766 226,269 250,640 262,051 Source: Census Bureau (2018). 2017 American Community Survey 1-year estimate Table: B15010. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 834 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 93 of 115 TABLE 89 United States Detailed Field of Bachelor’s Degree for First Major for the Population 25 Years and Over 2014 2015 2016 2017 United States Total 64,255,026 66,241,553 68,334,277 70,765,915 Science and Engineering Computers, Mathematics and Statistics 2,839,305 2,994,162 3,070,646 3,295,041 Biological, Agricultural and Environmental Sciences 3,943,346 4,084,323 4,261,869 4,462,181 Physical and Related Sciences 2,109,399 2,072,146 2,158,914 2,203,957 Psychology 3,018,445 3,125,659 3,270,563 3,392,209 Social Sciences 4,941,702 5,102,173 5,221,852 5,325,019 Engineering 5,004,316 5,212,950 5,357,590 5,626,061 Multidisciplinary Studies 421,146 431,426 463,442 516,502 Science and Engineering Related Fields 5,922,912 6,180,927 6,487,863 6,784,663 Business 13,116,144 13,585,532 13,874,749 14,374,483 Education 8,345,701 841,457 8,546,076 8,636,768 Arts, Humanities and Other Literature and Languages 2,760,995 2,851,805 2,927,045 2,990,063 Liberal Arts and History 3,242,151 3,282,681 3,373,305 3,445,951 Visual and Performing Arts 2,600,701 2,687,762 2,812,759 2,902,778 Communications 2,470,219 2,549,845 2,665,764 2,739,387 Other 3,518,544 3,662,705 3,841,839 4,070,852 Source: Census Bureau (2018). 2017 American Community Survey 1-year estimate Table: B15010. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 835 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 94 of 115 Recreation, Arts, and Leisure From 2014 to 2018, the percentage of total employment in Collier County has decreased, and it is projected to continue to decrease in 2020. In the State of Florida, the percentage of total employment began to increase in 2015; however, it is projected to continue decreasing. In the United States, the percentage of total employment increased in 2015; however, it is expected to continue decreasing. TABLE 90 Employment in Arts, Entertainment, and Recreation (in thousands of jobs) 2014 2015 2016 2017 2018* 2020* Collier County 9,548 9,678 9,697 9,761 10,330 10,696 % of Total Employment 4.70% 4.65% 4.55% 4.44% 4.41% 4.27% Florida 329,007 339,632 342,790 346,686 353,873 365,504 % of Total Employment 3.02% 3.05% 3.02% 2.96% 2.85% 2.84% United States 4,182,250 4,288,845 4,316,562 4,353,597 4,445,347 4,577,344 % of Total Employment 2.25% 2.27% 2.25% 2.22% 2.19% 2.19% Source: Woods & Poole Economics. (2018). 2018 State Profile: Florida [DATA FILE]. Washington, DC: Author. (*Forecast Estimation) GRAPH 38 Employment in Arts, Entertainment, and Recreation Source: Woods & Poole Economics. (2018). 2018 State Profile: Florida [DATA FILE]. Washington, DC: Author. (*Forecast Estimation) 0.00% 1.00% 2.00% 3.00% 4.00% 5.00% 6.00% 2014 2015 2016 2017 2018*2020*Percent of Total EmploymentEmployment in Arts, Entertainment, and Recreation United States Florida Collier County 30.A.2 Packet Pg. 836 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 95 of 115 From 2014 to 2016, Collier County has experienced an upward trend in earnings in arts, entertainment, and recreations. This trend can also be seen in the State of Florida, as well as the United States. From 2017 to 2018, the trend moved downward for Collier County, the State of Florida, and the United States; however, it is projected that the trend will move upward in 2020. TABLE 91 Earnings in Arts, Entertainment, & Recreations (in millions of 2009 dollars) 2014 2015 2016 2017 2018* 2020* Collier County 368,064 377,129 386,676 359,041 333,203 350,203 % of Total Employment 181.37% 181.19% 181.25% 163.41% 142.12% 139.86% Florida 10,246,102 10,492,939 10,740,588 10,495,826 10,494,180 10,954,610 % of Total Employment 93.90% 94.26% 94.62% 89.59% 84.59% 84.97% United States 109,580,948 111,752,297 114,076,457 120,846,434 124,437,500 129,119,200 % of Total Employment 58.98% 59.17% 59.45% 61.70% 61.41% 61.91% Source: Woods & Poole Economics. (2018). 2018 State Profile: Florida [DATA FILE]. Washington, DC: Author. (*Forecast Estimation) Nonprofits in Arts, Entertainment, & Recreation As of August 2016, 5.69 percent of Collier County’s total registered nonprofit organizations were classified as “Arts, Culture, and Humanities.” This is less than the State of Florida with 6.16 percent and the United States with 7.49 percent. TABLE 92 Registered Nonprofit Organizations Arts, Culture, and Humanities Environment Animal Related Total Registered Nonprofit Organizations Collier County 97 41 56 1,706 Florida 5,052 1,373 1,959 82,056 United States 118,498 35,314 28,084 1,581,445 Source: Internal Revenue Service. (2018). Exempt organizations business master file, The Urban Institute, National Center for Charitable Statistics. Retrieved from http://nccsdataweb.urban.org 30.A.2 Packet Pg. 837 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 96 of 115 In both Collier County and the State of Florida, the highest percentage of students in PK-12 participated in music, followed by visual arts, theatre, and dance. TABLE 93 Percentage of Students (PK-12) Who Participated in a Fine Arts Discipline 2013-14 2014-15 2015-16 2016-17 2017-18 Collier County Dance 0.1% 0.0% 0.0% 0.6% 0.7% Theatre 1.0% 1.1% 2.2% 1.4% 1.3% Visual Arts 54.6% 54.9% 54.7% 55.0% 52.9% Music 57.7% 57.8% 57.1% 56.2% 55.0% Florida Dance 1.7% 1.7% 1.8% 1.9% 1.9% Theatre 3.3% 3.5% 3.7% 3.7% 3.8% Visual Arts 41.3% 41.8% 42.8% 42.8% 43.1% Music 44.6% 44.8% 45.4% 45.3% 45.1% Source: Florida Department of Education. (2018). 2017-18 Fine Arts Students of Total Students by Discipline. Retrieved from http://edstats.fldoe.org TABLE 94 Number of Fine Arts Classes by Discipline (PK-12) 2013-14 2014-15 2015-16 2016-17 2017-18 Collier County Dance 3 - - 17 26 Theatre 31 46 80 66 54 Visual Arts 652 586 591 650 634 Music 731 697 705 691 705 Florida Dance 2,672 2,549 2,753 2,933 3,081 Theatre 5,328 6,059 6,415 6,402 6,665 Visual Arts 31,848 31,068 31,871 333,556 34,054 Music 39,440 39,530 40,649 41,740 42,124 Source: Florida Department of Education. (2018). 2017-18 Fine Arts Teachers and Classroom. Retrieved from http://edstats.fldoe.org 30.A.2 Packet Pg. 838 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 97 of 115 Charitable Giving In 2011 and 2013, Collier County has had the highest AGI average on itemized returns, as well as the percentage of itemized returns and average itemized contributions reported, compared to the State of Florida and the United States. TABLE 95 Average Charitable Giving and Adjusted Gross Income (Household Income by Zip) Number of Itemized Tax Returns Filed Average AGI on Itemized Returns Number of Itemized Returns Reporting Contributions % of Itemized Returns Average Itemized Contribution reported % of Average Itemized Contribution reported 2013 Collier County 52,270 $ 266,916 43,910 84.01% $ 13,885 5.20% Florida 2,184,920 $ 132,502 1,770,130 81.02% $ 5,823 4.39% United States 44,380,440 $ 124,224 36,478,140 82.19% $ 4,928 3.97% 2012 Collier County 53,030 $ 306,412 44,360 83.65% $ 14,642 4.78% Florida 2,277,630 $ 142,131 1,829,820 80.34% $ 5,698 4.01% United States 45,592,210 $ 126,262 37,298,370 81.81% $ 4,802 3.80% 2011 Collier County 52,695 $ 305,788 43,512 82.57% $ 11,418 3.73% Florida 2,358,331 $ 213,650 1,862,177 78.96% $ 4,884 2.29% United States 46,813,356 $ 183,128 38,009,698 81.19% $ 4,308 2.35% Source: Internal Revenue Service, Charitable Giving by Households that Itemize Deductions (AGI and Itemized Contributions Summary by Zip, 2011, 2012, 2013. The Urban Institute, National Center for Charitable Statistics. Retrieved from http://nccsdataweb.urban.org/ 30.A.2 Packet Pg. 839 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 98 of 115 GRAPH 39 Itemized Tax Return Reporting Contributions Source: Internal Revenue Service, Charitable Giving by Households that Itemize Deductions (AGI and Itemized Contributions Summary by Zip, 2011, 2012, 2013. The Urban Institute, National Center for Charitable Statistics. Retrieved from http://nccsdataweb.urban.org/ Residents of the State of Florida and the United States who earn $75,000 or higher itemize at least 83.54 percent of their tax returns and on average, contribute at least $3,253 of their income to charitable causes. Data for Collier County is not reported to the National Center for Charitable Statistics. TABLE 96 Florida–Average Charitable Giving and Adjusted Gross Income by Income Level AGI Size Number of Itemized Tax Returns Filed Average AGI on Itemized Returns Number of Itemized Returns Reporting Contributions % of Itemized Tax Returns Filed Average Itemized Contributions Reported % of average AGI on Itemized Returns Florida $1 under $25,000 259,540 $ 15,470 162,970 62.79% $ 1,835 11.86% $25,000 under $50,000 478,030 $ 37,447 352,930 73.83% $ 2,571 6.87% $50,000 under $75,000 397,740 $ 61,902 321,870 80.92% $ 3,159 5.10% $75,000 under $100,000 298,930 $ 86,917 254,540 85.15% $ 3,736 4.30% $100,000 under $200,000 506,070 $ 137,519 451,530 89.22% $ 4,753 3.46% $200,000 or more 244,610 $ 602,567 226,290 92.51% $ 22,037 3.66% Source: Internal Revenue Service, Charitable Giving by Households that Itemize Deductions (AGI and Itemized Contributions Summary by Zip, 2013). The Urban Institute, National Center for Charitable Statistics. Retrieved from http://nccsdataweb.urban.org/ 78.00% 79.00% 80.00% 81.00% 82.00% 83.00% 84.00% 2011 2012 2013Percent of all itemized tax returnReporting Chartiable Contribution Collier County Florida United States 30.A.2 Packet Pg. 840 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 99 of 115 TABLE 97 United States–Average Charitable Giving and Adjusted Gross Income by Income Level AGI Size Number of Itemized Tax Returns Filed Average AGI on Itemized Returns Number of Itemized Returns Reporting Contributions % of Itemized Tax Returns Filed Average Itemized Contributions Reported % of average AGI on Itemized Returns United States $1 under $25,000 3,531,590 $ 15,066 2,282,770 64.64% $ 1,889 12.54 $25,000 under $50,000 7,352,780 $ 38,274 5,389,430 73.30% $ 2,517 6.58% $50,000 under $75,000 8,125,380 $ 62,351 6,450,670 79.39% $ 2,874 4.61% $75,000 under $100,000 7,202,730 $ 87,249 6,016,940 83.54% $ 3,253 3.73% $100,000 under $200,000 13,016,250 $ 137,926 11,553,640 88.76% $ 4,089 2.96% $200,000 or more 5,151,670 $ 501,783 4,784,690 92.88% $ 15,886 3.17% Source: Internal Revenue Service, Charitable Giving by Households that Itemize Deductions (AGI and Itemized Contributions Summary by Zip, 2013). The Urban Institute, National Center for Charitable Statistics. Retrieved from http://nccsdataweb.urban.org/ Volunteering Statewide, the 55-64 population has the largest amount of hours volunteering and the 75 and over population has the largest amount of hours nationwide. The age group 65-74 has the highest volunteer rate in Florida with 22.18 percent and the 35-44 population has the highest rate nationwide with 29.75 percent. TABLE 98 Volunteer Rates and Hours by Age Group 16-19 20-24 25-34 35-44 45-54 55-64 65-74 75+ Florida Rate 20.03 13.96 16.59 20.23 21.41 20.49 22.18 14.47 Hours - - 48 48 52 64 - - United States Rate 26.21% 18.55% 22.04% 29.75% 28.26% 25.64% 26.47% 19.96% Hours 40 40 32 45 52 53 81 100 Source: Corporation for National and Community Service. (2018). 2015 Volunteering and Civic Engagement. Retrieved from www.volunteeringinamerica.gov 30.A.2 Packet Pg. 841 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 100 of 115 In the State of Florida, the percentage of the population that donates time to volunteerism is less than the percentage of the population of the United States that donates their time to volunteerism. TABLE 99 Volunteer Rates and Hours by Race White Black Native Am / Alaskan Asian Hawaiian / Pacific Is. More than one RNO Florida Rate 19.42% 17.96% - 14.37% - 23.90% Hours 60 68 - - - - United States Rate 26.70% 19.18% 18.90% 18.36% 24.45% 26.61% Hours 50 52 50 40 48 46 Source: Corporation for National and Community Service. (2018). 2015 Volunteering and Civic Engagement. Retrieved from www.volunteeringinamerica.gov GRAPH 40 Volunteer Rate Source: Corporation for National and Community Service. (2018). 2015 Volunteering and Civic Engagement. Retrieved from www.volunteeringinamerica.gov 15.00% 17.00% 19.00% 21.00% 23.00% 25.00% 27.00% 29.00% 31.00% 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Volunteer Rate United States Florida 30.A.2 Packet Pg. 842 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 101 of 115 People in both the State of Florida and the United States tend to donate the largest amount of time to religious causes, educational endeavors, and social service causes; however, they donate less of a percentage of their time to health-related causes, civic causes, sports and arts, and other causes. GRAPH 41 Volunteer Interest Areas Source: Corporation for National and Community Service. (2018). 2015 Volunteering and Civic Engagement. Retrieved from www.volunteeringinamerica.gov Residents of the State of Florida and the United States tend to devote the largest portion of their volunteering hours in activities relating to fundraising and collection/distributing of food. GRAPH 42 Top 5 Volunteer Activities Source: Corporation for National and Community Service. (2018). 2015 Volunteering and Civic Engagement. Retrieved from www.volunteeringinamerica.gov 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% Civic Educational Health Religious Social Service Sports/ Arts Other Volunteer Interest Areas Florida United States 18.80% 24.00% 24.20% 17.50% 18.00% 14.30% 20.00% 21.00% 14.50% 14.60% General Labor Fundaraiser Collect/ Distr. Food Mentor Youth Tutor/ Teach Top 5 Volunteer Activities Florida United States 30.A.2 Packet Pg. 843 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 102 of 115 Collier County 211 Caller Statistics From 2013 to 2017, there has been a gradual increase in the amount of people calling Collier County 2-1-1 requesting assistance. Data was not available for July 2015 through December 2015. TABLE 100 Collier County 2-1-1 Total Calls per Month by Fiscal Year 2013-2014 2014-2015 2015-2016 2016-2017 July 119 255 - 215 August 179 201 - 253 September 284 253 - 261 October 202 286 - 274 November 161 178 - 236 December 164 177 - 230 January 180 181 150 227 February 170 147 136 291 March 237 166 160 338 April 221 184 129 314 May 250 161 147 229 June 211 162 134 301 Year Total 1,497 2,378 2,351 856 Source: Collier 2-1-1. (2018). 2016 - 2017 Caller Statistics Monthly Report. Retrieved from http://www.collier211.org 30.A.2 Packet Pg. 844 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 103 of 115 From July 2016 to June 2017, housing and shelter assistance, food, utilities, healthcare, and mental health and addictions were the top five needs for county residents. TABLE 101 Collier County 2-1-1 Call Problems/Needs for July 2017-June 2018 Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Housing & Shelter 121 124 242 338 177 169 137 81 130 149 166 115 Food 38 56 244 193 166 65 42 44 34 68 58 44 Utilities 70 97 194 424 133 112 97 50 68 67 67 74 Healthcare 34 31 22 28 35 21 38 27 58 32 46 22 Mental Health & Addictions 8 23 2 16 16 9 17 8 35 30 29 14 Employment & Income 21 15 46 43 17 13 43 163 184 111 26 9 Clothing & Household 5 15 46 48 13 14 10 7 11 5 26 3 Childcare & Parenting 6 9 2 15 11 9 0 1 0 5 1 5 Government & Legal 5 10 16 30 21 16 21 23 22 22 21 9 Transportation Assistance 4 6 7 11 5 14 9 12 13 11 10 13 Education 3 3 1 0 0 2 1 1 0 0 1 0 Disaster 2 6 805 219 42 14 7 4 7 3 28 16 Other 32 33 41 27 23 25 25 29 32 16 14 18 Source: Collier 2-1-1. (2018) 2017-2018 2-1-1 Counts. Retrieved from http://www.collier211.org Between May and August, females made the most calls to Collier County 2-1-1. Data was not available prior to May 2018. TABLE 102 Collier County 2-1-1 Total Calls per Month per Gender for May 2018–August 2018 May June July August Female 261 253 340 239 Male 116 86 106 80 Unknown/Refused 116 3 0 17 Source: Collier 2-1-1. (2018) 2018 2-1-1 Counts. Retrieved from http://www.collier211.org 30.A.2 Packet Pg. 845 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 104 of 115 Between May and August, people in the age ranges of 18 to 29, 30 to 39, 50 to 59, and 60 and above called the Collier County 2-1-1 phone line the most. Data was not available prior to May 2018. TABLE 103 Collier County 2-1-1 Total Calls per Month per Gender for May–August 2018 May June July August 0 to 18 0 0 0 0 18 to 29 10 16 13 10 30 to 39 11 2 15 1 40 to 49 9 5 10 0 50 to 59 8 35 22 10 60 and above 44 34 32 31 Not Available 411 250 354 284 Source: Collier 2-1-1. (2018) 2018 2-1-1 Counts. Retrieved from http://www.collier211.org Children and Child Care The amount of reported child day care establishments increased in Collier County, the state of Florida, and the United States in 2017. TABLE 104 Private Child Day Care Services by Population Under 5 years 2013 2014 2015 2016 2017 Collier County Number of Establishments 44 47 45 47 49 Number of employees 781 769 765 964 974 Total Wages in thousands 18,015 18,591 18,488 22,551,717 23,603,460 Average Weekly Wage 444 465 465 450 466 Average Annual Pay 23,067 24,165 24,175 23,386 24,234 Population under 5 years 16,518 16,620 16,793 16,870 17,022 Children per 1 day care 375 354 373 359 347 Florida Number of Establishments 4,211 4,124 4,030 4,085 4,108 Number of employees 49,623 49,839 51,127 53,177 54,689 Total Wages in thousands 953,605 978,210 1,028,690 1,098,858 1,163,071 Average Weekly Wage 370 377 387 397 409 Average Annual Pay 19,217 19,627 20,120 20,664 21,267 Population under 5 years 1,076,020 1,084,349 1,099,832 1,114,110 1,138,337 Children per 1 day care 256 263 273 273 277 United States Number of Establishments 70,007 69,819 70,067 70,877 71,233 Number of employees 788,254 799,437 824,359 850,196 873,154 Total Wages in thousands 15,735,442 16,374,041 17,454,791 18,429,254 19,522,015 30.A.2 Packet Pg. 846 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 105 of 115 Average Weekly Wage 384 394 407 417 430 Average Annual Pay 19,962 20,482 21,174 21,676 22,358 Population under 5 years 19,867,850 19,867,880 20,122,640 20,168,520 20,224,410 Children per 1 day care 284 285 287 285 284 Source: Bureau of Labor Statistics. (2018). Quarterly Census of Employment and Wages. Retrieved from http://www.bls.gov; Woods & Poole Economics. (2018) 2018 state profile: Florida. Washington, DC: Author. GRAPH 43 Children per Day Care Ratio Source: Bureau of Labor Statistics. (2018). Quarterly Census of Employment and Wages. Retrieved from http://www.bls.gov; Woods & Poole Economics. (2018) 2018 state profile: Florida. Washington, DC: Author. 0 50 100 150 200 250 300 350 400 2013 2014 2015 2016 2017 Children per Day Care Ratio Collier County Florida United States 30.A.2 Packet Pg. 847 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 106 of 115 From 2013 to 2017 in Collier County, the percent of the population that is under 5 years and the percent of the population that is in day care have both fluctuated. GRAPH 44 Change in Population Under 5 Years and Change in Child Day Care Source: Bureau of Labor Statistics. (2018). Quarterly Census of Employment and Wages. Retrieved from http://www.bls.gov; Woods & Poole Economics. (2018) 2018 state profile: Florida. Washington, DC: Author. 2013 2014 2015 2016 2017 Population under 5 years -0.89%0.62%1.04%0.46%0.90% Children per 1 day care -0.89%-5.80%5.53%-3.82%-3.22% -10.00% -5.00% 0.00% 5.00% 10.00% 15.00%Percentage ChangeCollier County Percentage Change of Population Under 5 Years and Percentage Change in Day Care 30.A.2 Packet Pg. 848 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 107 of 115 From 2014 to 2017 in Collier County, the percentage of female householders with no husband was higher than male householders with no wife. Overall, female householders with no husband have a higher percentage than males in the United States, followed by Collier County and Florida. TABLE 105 Householder with Own Children Under 18 and No Spouse Present 2014 2015 2016 2017 Collier County Male Householder, no wife present 4,662 5,552 4,597 6,882 With own children under 18 years 1,999 3,287 2,192 3,353 As % of all Male householder, no wife present 42.88% 59.20% 47.68% 48.72% Female Householder, no husband present 11,482 12,618 12,157 12,594 With own children under 18 years 6,121 6,697 6,427 6,478 As % of all Female householder, no husband present 53.31% 53.07% 52.87% 51.44% Florida Male Householder, no wife present 353,537 359,661 364,873 377,628 With own children under 18 years 155,425 161,212 157,756 167,868 As % of all Male householder, no wife present 43.96% 44.82% 43.24% 44.45% Female Householder, no husband present 959,771 1,002,174 985,794 977,583 With own children under 18 years 494,344 502,732 495,544 469,659 As % of all Female householder, no husband present 51.51% 50.16% 50.27% 48.04% United States Male Householder, no wife present 5,765,116 5,730,981 5,794,777 5,886,661 With own children under 18 years 2,736,649 2,718,895 2,709,515 2,723,009 As % of all Male householder, no wife present 47.47% 47.44% 46.76% 46.26% Female Householder, no husband present 15,272,285 15,083,980 15,023,387 14,896,928 With own children under 18 years: 8,257,048 8,072,458 7,942,075 7,789,620 As % of all Female householder, no husband present 54.07% 53.52% 52.86% 52.29% Source: Census Bureau. (2018) 2017 American Community Survey: Table B11003. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 849 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 108 of 115 TABLE 106 Percentage of All Married-Couples and Single Parents with Own Children Under 18 2014 2015 2016 2017 Collier County All Families 91,539 95,011 91,425 97,195 Married-couple w/ Children under 18 19,380 17,853 16,773 16,440 As % of Married-couple w/ Children under 18 21.17% 18.79% 18.35% 16.91% Single Male w/ Children under 18 1,999 3,287 2,192 3,353 As % of Single Male w/ Children under 18 2.18% 3.46% 2.40% 3.45% Single Female w/ Children under 18 6,121 6,697 6,427 6,478 As % of Single Female w/ Children under 18 6.69% 7.05% 7.03% 6.66% Florida All Families 4,693,411 4,806,611 4,864,461 4,943,506 Married-couple w/ Children under 18 1,097,577 1,117,422 1,133,704 1,163,791 As % of Married-couple w/ Children under 18 23.39% 23.25% 23.31% 23.54% Single Male w/ Children under 18 155,425 161,212 157,756 167,868 As % of Single Male w/ Children under 18 3.31% 3.35% 3.24% 3.40% Single Female w/ Children under 18 494,344 502,732 495,544 469,659 As % of Single Female w/ Children under 18 10.53% 10.46% 10.19% 9.50% United States All Families 77,152,072 77,530,756 77,785,962 78,631,163 Married-couple w/ Children under 18 22,112,890 22,208,234 22,188,306 22,334,270 As % of Married-couple w/ Children under 18 28.66% 28.64% 28.52% 28.40% Single Male w/ Children under 18 2,736,649 2,718,895 3,085,262 2,723,009 As % of Single Male w/ Children under 18 3.55% 3.51% 3.97% 3.46% Single Female w/ Children under 18 8,257,048 8,072,458 7,081,312 7,789,620 As % of Single Female w/ Children under 18 10.70% 10.41% 9.10% 9.91% Source: Census Bureau. (2018) 2017 American Community Survey: Table B11003. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 850 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 109 of 115 The total number of grandchildren less than 18 years living with their grandparents increased in Collier County in 2016, before declining in 2017. The total number of grandchildren less than 18 years living with their grandparents has been gradually increasing in the State of Florida from 2014 to 2017. The total number of grandchildren under 18 years living with their grandparents has gradually trended upward in the United States from 2014 to 2016, before declining in 2017. TABLE 107 Grandchildren Under 18 Years Living with Grandparents 2014 2015 2016 2017 Collier County Total 4,500 4,116 7,701 4,049 Under 6 years 1,502 2,417 3,936 1,895 6 to 11 years 1,605 1,143 2,874 1,286 12 to 17 years 1,393 556 891 868 Florida Total 352,311 359,892 373,692 378,068 Under 6 years 159,120 162,973 155,055 161,792 6 to 11 years 114,861 113,228 127,101 129,641 12 to 17 years 78,330 83,691 91,536 86,635 United States Total 5,829,891 5,886,720 5,964,069 5,956,765 Under 6 years 2,673,367 2,647,137 2,589,817 2,559,565 6 to 11 years 1,819,225 1,877,805 1,963,246 1,955,033 12 to 17 years 1,337,299 1,361,778 1,411,006 1,442,167 Source: Census Bureau. (2018) 2017 American Community Survey: Table B10001. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 851 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 110 of 115 Children in Poverty From 2013 to 2017, the percentage of children under 5 years living below the poverty level in the State of Florida and the United States has gradually declined. During this same time period, the percentage of children under 5 years living below the poverty level in Collier County has gradually declined before steadily increasing. GRAPH 45 Percentage of Related Children Under 5 Years Living Below Poverty Level Source: Census Bureau. (2018). 2017 American Community Survey: Table CP03. Retrieved from http://factfinder.census.gov 2013 2014 2015 2016 2017 Collier County 23.6%33.6%30.7%15.8%26.2% Florida 27.0%26.2%25.8%23.2%21.7% United States 24.8%23.9%22.8%21.3%20.2% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0%PercentagePercentage of Related Children Under 5 Years Living Below Poverty Level 30.A.2 Packet Pg. 852 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 111 of 115 From 2013 to 2017, the percentage of related children 5-17 years living below the poverty level in the State of Florida and the United States has gradually declined. During this same time period, the percentage of related children 5-17 years living below the poverty level in Collier County has gradually declined before steadily increasing. GRAPH 46 Percentage of Related Children 5-17 Years Living Below Poverty Level Source: Census Bureau. (2018). 2017 American Community Survey: Table CP03. Retrieved from http://factfinder.census.gov 2013 2014 2015 2016 2017 Collier County 20.5%25.0%22.3%16.7%24.1% Florida 23.1%22.5%21.6%19.8%19.3% United States 20.8%20.4%19.5%18.3%17.3% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0%PercentagePercentage of Related Children 5-17 Years Living Below Poverty Level 30.A.2 Packet Pg. 853 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 112 of 115 From 2013 to 2017 in Collier County, the State of Florida, and the United States the percentage of families and people whose income in the past 12 months is below the poverty level has been the highest for families with a female householder, no husband present with related children under 18 years and related children under 5 years. TABLE 108 Percentage of Families and People Whose Income in the Past 12 Months is Below Poverty Level 2013 2014 2015 2016 2017 Collier County All families 8.8% 8.9% 9.3% 6.3% 8.2% With related children under 18 years 16.8% 20.5% 19.9% 12.7% 19.1% With related children under 5 years only 15.1% 11.6% 19.3% 2.7% 20.3% Married couple families 6.8% 4.9% 6.4% 3.8% 5.7% With related children under 18 years 13.6% 12.8% 13.6% 7.3% 11.8% With related children under 5 years only 6.5% 9.4% 7.8% 0.0% 0.0% Families with female householder, no husband present 15.4% 27.8% 18.8% 18.1% 24.3% With related children under 18 years 19.3% 37.7% 26.8% 22.6% 38.8% With related children under 5 years only 14.1% 22.2% 48.1% 7.6% 68.7% Florida All families 12.4% 12.0% 11.3% 10.5% 10.1% With related children under 18 years 20.3% 19.9% 18.9% 17.1% 16.3% With related children under 5 years only 18.8% 19.3% 17.3% 16.4% 14.0% Married couple families 7.0% 6.6% 6.1% 6.1% 6.0% With related children under 18 years 10.4% 9.6% 9.1% 8.6% 8.0% With related children under 5 years only 7.7% 8.2% 7.0% 6.9% 6.5% Families with female householder, no husband present 29.1% 29.4% 27.0% 25.0% 24.0% With related children under 18 years 38.7% 39.7% 37.1% 33.8% 34.0% With related children under 5 years only 40.9% 42.7% 39.6% 37.0% 33.6% United States All families 11.6% 11.3% 10.6% 10.0% 10.0% With related children under 18 years 18.5% 18.0% 17.1% 15.9% 15.0% With related children under 5 years only 18.3% 17.5% 16.4% 15.1% 14.2% Married couple families 5.8% 5.6% 5.2% 5.1% 4.8% With related children under 18 years 8.5% 8.2% 7.7% 7.1% 6.6% With related children under 5 years only 7.0% 6.5% 5.9% 5.3% 5.1% Families with female householder, no husband present 30.9% 30.5% 29.0% 27.3% 26.2% With related children under 18 years 41.0% 40.6% 39.2% 37.0% 35.7% With related children under 5 years only 46.2% 45.4% 43.9% 41.4% 40.2% Source: Census Bureau. (2018). 2017 American Community Survey: Table CP03. Retrieved from http://factfinder.census.gov 30.A.2 Packet Pg. 854 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 113 of 115 From 2013 to 2017, Collier County’s percentage of households receiving food stamps/SNAP with children under 18 was above the state and national percentage. In the State of Florida and the United States, the percentage of households receiving food stamps/SNAP has gradually decreased; however, in 2017, the State of Florida’s percentage increased. TABLE 109 Percentage of Households Receiving Food Stamps/SNAP with Children Under 18 2013 2014 2015 2016 2017 Collier County 56.8% 60.7% 67.2% 63.8% 59.5% Florida 48.8% 48.6% 48.5% 47.5% 48.0% United States 54.0% 52.9% 52.1% 50.8% 50.1% Source: Census Bureau (2018) 2017 American Community Survey 1-Year Estimate Table: S2201. Retrieved from https://factfinder.census.gov Domestic Violence In Collier County and the State of Florida during 2013-2017, the most reported domestic violence offense was simple assault, followed by aggravated assault and threat/intimidation. TABLE 110 Reported Domestic Violence Offenses for 2013-2017 2013 2014 2015 2016 2017 Collier County Total Population 333,663 336,783 343,802 350,202 357,470 Murder 3 2 0 5 2 Manslaughter 0 0 0 0 0 Forcible Rape 34 16 25 22 29 Forcible Fondling 11 6 11 4 18 Aggrav. Assault 241 236 269 217 322 Aggrav. Stalking 4 0 0 1 0 Simple Assault 1,114 1,258 1,198 1167 1272 Threat/Intimidation 18 20 33 43 54 Stalking 2 1 0 0 0 Total Reported Offenses 1,427 1,539 1,536 1459 1697 Florida Total Population 19,259,543 19,457,270 19,815,183 20,148,654 20,484,142 Murder 170 193 184 179 162 Manslaughter 17 12 15 14 18 Forcible Rape 1,588 1,417 1,517 1,535 1,580 Forcible Fondling 744 692 756 713 762 Aggrav. Assault 17,043 17,040 17,354 16,734 16,657 Aggrav. Stalking 201 136 153 171 189 Simple Assault 85,606 84,994 85,608 84,382 85,721 Threat/Intimidation 2,161 2,010 1,641 1,502 1,521 30.A.2 Packet Pg. 855 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 114 of 115 Stalking 500 388 438 410 369 Total Reported Offenses 108,030 106,882 107,666 105,640 106,979 Source: Florida Department of Law Enforcement. (2018). Florida’s County and Jurisdictional Reported Domestic Violence Offenses, 2017. Retrieved from https://www.fdle.state.fl.us In 2013-2017, the reported domestic violence offenses rate per 100,000 of the population has fluctuated for Collier County; however, the rate has continued to decline for the State of Florida. TABLE 111 Collier County and Florida Reported Domestic Violence Offenses Rate per 100,000 Population from 2013 to 2017 2013 2014 2015 2016 2017 Collier County 427.68 457 446.8 416.6 474.7 Florida 560.92 547.9 543.4 524.3 522.3 Source: Florida Department of Law Enforcement. (2018). Total Reported Domestic Violence Offenses by County, 1992-2017. Retrieved from https://www.fdle.state.fl.us GRAPH 47 Domestic Violence Offense Rate Source: Florida Department of Law Enforcement. (2018). Total Reported Domestic Violence Offenses by County, 1992-2017. Retrieved from https://www.fdle.state.fl.us 400 420 440 460 480 500 520 540 560 580 2013 2014 2015 2016 2017Rate Per 100,000 PopulationDomestic Violence Offense Rate Collier County Florida 30.A.2 Packet Pg. 856 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2018 Vital Signs Report HU Johnson School of Business Page 115 of 115 In the State of Florida during 2014-2017, the National Human Trafficking Resource Center received the majority of their inbound phone calls for sex trafficking, followed by labor trafficking. The majority of inbound phone callers were females, and the majority of the callers were U.S. citizens. TABLE 112 National Human Trafficking Resource Center Inbound Phone Call Statistics 2014 2015 2016 2017 Florida Total Number of Calls 1,428 1,518 1,623 1,601 Human Trafficking Cases Reported 360 410 555 604 Types of Trafficking Reported Sex Trafficking 245 308 406 402 Labor Trafficking 69 69 92 137 Trafficking Type Not Specified 24 21 28 32 Sex and Labor 22 12 29 33 Gender Male 54 53 87 95 Female 297 351 470 504 Age Adult 247 294 385 425 Minor 110 121 173 182 Citizenship US Citizen 155 147 168 153 Foreign National 80 81 116 145 United States Total Number of Calls 21,431 21,941 26,727 26,557 Human Trafficking Cases Reported 5,041 5,575 7,565 8,524 Types of Trafficking Reported Sex Trafficking 3,593 4,183 5,549 6,081 Labor Trafficking 815 728 1,055 1,249 Trafficking Type Not Specified 452 492 691 817 Sex and Labor 181 172 270 377 Gender Male 686 580 978 1,124 Female 4,170 4,739 6,344 7,067 Age Adult 3,290 3,612 4,888 5,278 Minor 1,587 1,653 2,389 2,495 Citizenship US Citizen 1,873 1,728 2,094 1,947 Foreign National 1,259 1,130 1,453 1,510 Source: National Human Trafficking Resource Center. (2018). Hotline Statistics. Retrieved from http://traffickingresourcecenter.org/ 30.A.2 Packet Pg. 857 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Mental Health and Addiction Ad Hoc Committee Meeting March 19, 2019 Item 8.3 – Review of Calgary Housing Solutions Provided by Dale Mullin Sean, See a copy of the following email and 3 attachments. A lot of material but very interesting material on homelessness in Calgary....a world class solution. Tim Hearn (Canadian) is the individual I spoke about. He is a part time resident of Collier County - Gray Oaks. ****************************************************************************** *********** Good morning, Tim Per your request, I am attaching some off the shelf material that we hope addresses what you are looking for. I’m sure that Diana will chime in if she has anything else to add. 1.) A Centralized Receiving System - Mental Health/Addiction Patients Attached is the Our Living Legacy report (you have this in hard copy, but now you can share it digitally). On pages 46- 48, you can find information on Coordinated Service Delivery, and more specifically on page 47, what we would call our centralized receiving system, Coordinated Access and Assessment (CAA). The goal is to serve the most vulnerable and acute first, which could certainly include those with mental health issues and addictions. You can find a helpful visual on how the process works on page 48. 2.) Permanent Supportive Housing (Scattered Sites & Supportive Services) Attached is the Together to Zero report (you also have this in hard copy). In the Strategic Directive 2 Section (Home for Everyone), there is a section on The Housing Continuum. In the visual, scattered site and place-based housing are a part of the Supportive Care Housing piece. This might be good context for the Ad Hoc group. The last attachment is an overview of Calgary’s Homeless Serving System of Care. Here you can find more details on CHF funded programs, both scattered site and placed based. 30.A.2 Packet Pg. 858 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Also, I know that you and Doug are well-versed in these areas, but Doug’s Ad Hoc Committee might benefit from an overview of the following terms and their specific definitions. You can find these definitions at the end of the attached Living Legacy Report. • PSH, Permanent supportive housing: Long term housing for people experiencing homelessness with deep disabilities (including cognitive disabilities) without a length of stay time limit. Support programs are made available, but the program does not require participation in these services to remain housed (Systems Planning Framework). • Supportive Housing: Supportive Housing provides case management and housing supports to individuals and families who are considered moderate to high acuity. In Supportive Housing programs, the goal for the client is that over time and with case management support, the client(s) will be able to achieve housing stability and independence. While there is no maximum length of stay in Supportive Housing programs, the housing and supports are intended to be non- permanent as the goal is for the client to obtain the skills to live independently, at which point the client will transition out of the program and into the community, where they may be linked with less intensive community-based services or other supports (Systems Planning Framework). • Place-based housing: Refers to physical housing with program supports for individuals typically with high acuity (Systems Planning Framework). • Scattered site housing: A housing model that utilizes individual rental units located throughout the community, typically owned by private market landlords. Rent supplements are typically applied. Again, we hope this is helpful to you, Tim. If you need anything else, please let me know. Best, Teresa Teresa Hiser Development Manager Calgary Homeless Foundation Main: 403.237.6456 teresah@calgaryhomeless.com www.calgaryhomeless.comesting reading. Galgary in know internationally for the work that have done in solving their homeless problems. 30.A.2 Packet Pg. 859 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Note: Permanent Supportive Housing-Housing Units contained in a central purpose built building from which people are not expected to graduate | Supportive Housing-Individual Housing units throughout the greater community with no time limit but from which people usually graduate Defined as: Prevention Services provide short term financial assistance and limited case management in order to prevent housing loss due to a housing crisis. Defined as: Outreach involves moving outside the walls of the agency to engage people experiencing homelessness who may be disconnected and alienated not only from mainstream services and supports, but from the services targeting homeless persons as well. Defined as: System-Level Priorities are unique and diverse programs which provide support to the greater Homeless Serving System of Care. Non-Market Housing Defined as: Non-market housing is typically described as subsidized, social or affordable housing units. Grad Rent Subsidy Defined as: GRS is a rent supplement program that provides financial assistance for clients to obtain and maintain affordable housing after completion of a support program. Defined as: Adaptive Case Management programs offer client directed, flexible supports and financial assistance to those experiencing homelessness, to secure and sustain housing. Defined as: Supportive Housing (SH) provides case management and housing supports to adults and families who are considered mid to high acuity. The goal is that over time and with case management support, the client(s) will be able to achieve housing stability and independence. Defined as: Permanent Supportive Housing (PSH) provides long term housing and support with no time limit for high acuity individuals experiencing major barriers and exhibiting complex needs, and who will require ongoing support to maintain their housing. Defined as: ACT is an integrated team-based approach designed to provide comprehensive community-based supports to help people remain stably housed. These teams may consist of physicians and other health care provides, social workers and peer support workers. Agency Program Aspen Family Home Stay Boys and Girls Club Unity Project Children’s Cottage Society HomeBridge Children’s Cottage Society Rapid Rehousing McMan Rapid Rehousing Agency Program Aboriginal Friendship Centre Outreach and Cultural Reconnection Alpha House DOAP Team Wood’s Homes Exit Reach Agency Program Distress Centre of Calgary CAA Team at SORCe Aboriginal Friendship Centre Indigenous Gathering Place Keys to Recovery Creation Lodge Keys to Recovery ASCHH Liaison Canadian Accreditation Council Accreditation Agency Program CUPS Community Development Agency Program CUPS Grad Rent Subsidy Program CUPS Graduated Housing Program Agency Program Children’s Cottage Fee for Service Closer to Home Fee for Service CUPS Fee for Service Discovery House Fee for Service Inn From The Cold Fee for Service **No target # of clients for Fee for Service programs Agency Program Alpha House Alpha Housing Accessible Housing Bridge to Home Aspen Family Sustainable Families Boys and Girls Club Aura Infinity Project Home Fire Children’s Cottage HomeLinks Calgary Dream Centre Living in Community Calgary John Howard Adult Housing Reintegration Roofs for Youth CUPS Key Case Management Discovery House Community Housing Inn from the Cold Housing with Intensive Supports McMan Hope Homes Hope Homes Aboriginal Aboriginal Friendship Centre Aboriginal Homeless Initiative The Alex HomeBase Keys To Recovery Keys To Recovery Inn From The Cold Journey House 1 Journey House 2 Metis Calgary Family Services Rainbow Lodge Wood’s New Horizon Alberta Health Services Bridgeland & Ophelia Supportive Housing Agency Program Alpha House Madison Francis Manor Sunalta Lodging House Aurora Women’s Housing Program The Alex Abbeydale Place Prelude Accessible Housing Newbridge CASS Stepping Stone Manor Langin Place YW of Calgary Providence Croydon Sharp Foundation Murrary’s House TBD The Maple * Opening 2018 Agency Program The Alex Pathways to Housing % of Funding: 3% % of Funding 3% % of Funding: 2% % of Funding: 9% % of Funding: 3% % of Funding: 46% % of Funding: 23% % of Funding: 11% Total $: 1,222,000 Total $: 1,595,000 Total $: 904,000 Total $: 4,169,000 Total $: 1,141,000 Total $: 21,072,000 Total $: 10,292,000 Total $: 5,187,000 # of Clients: N/A # of Clients: N/A # of Clients: N/A # of Clients: 476 # of Clients: 20** # of Clients: 1200 # of Clients: 310 # of Clients: 200 Cost/Client: N/A Cost/Client: N/A Cost/Client: N/A Cost/Client: $8759 Cost/Client: N/A Cost/Client: $17,560 Cost/Client: $33,200 Cost/Client: $25,935 30.A.2 Packet Pg. 860 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Updated: 31 August 2018 Prevention Services 3% Outreach 3% Non-Market Housing & GRS 9%System-Level Priorities 2% Adaptive Case Management 3% Supportive Housing 46% Permanent Supportive Housing 23% Assertive Community Treatment (ACT) 11% Supportive Housing $21,072,000 Permanent Supportive Housing $10,292,000 ACT $5,187,000 Non-Market Housing & GRS $4,169,000 Outreach $1,595,000 Prevention Services $1,222,000 Adaptive Case Management $1,141,000 System-Level Priorities $ 904,000 30.A.2 Packet Pg. 861 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Updated: 31 August 2018 Defined as: Prevention Services provide short term financial assistance and limited case management in order to prevent housing loss due to a housing crisis. Defined as: Outreach involves moving outside the walls of the agency to engage people experiencing homelessness who may be disconnected and alienated not only from mainstream services and supports, but from the services targeting homeless persons as well. Defined as: System-Level Priorities are unique and diverse programs which provide support to the greater Homeless Serving System of Care. Non-Market Housing Defined as: Non-market housing is typically described as subsidized, social or affordable housing units. Grad Rent Subsidy Defined as: GRS is a rent supplement program that provides financial assistance for clients to obtain and maintain affordable housing after completion of a support program. Defined as: Adaptive Case Management programs offer client directed, flexible supports and financial assistance to those experiencing homelessness, to secure and sustain housing. Defined as: Supportive Housing (SH) provides case management and housing supports to individuals and families who are considered mid to high acuity. In this program type, the goal for the client is that over time and with case management support, the client(s) will be able to achieve housing stability and independence. Defined as: Permanent Supportive Housing (PSH) provides long term housing and support with no time limit for high acuity individuals experiencing major barriers and exhibiting complex needs, and who will require ongoing support to maintain their housing. Defined as: ACT is an integrated team-based approach designed to provide comprehensive community-based supports to help people remain stably housed. These teams may consist of physicians and other health care provides, social workers and peer support workers. Agency Program Agency Program Alpha House DOAP Team Aboriginal Friendship Centre Outreach and Cultural Reconnection Agency Program Distress Centre of Calgary CAA Team at SORCe Aboriginal Friendship Centre Indigenous Gathering Place Keys to Recovery Creation Lodge Keys to Recovery ASCHH Liaison Canadian Accreditation Council Accreditation Agency Program CUPS Community Development Agency Program CUPS Grad Rent Subsidy Program CUPS Graduated Housing Program Agency Program Agency Program Alpha House Alpha Housing Accessible Housing Bridge to Home Calgary Dream Centre Living in Community Calgary John Howard Adult Housing Reintegration CUPS Key Case Management Aboriginal Friendship Centre Aboriginal Homeless Initiative The Alex HomeBase Keys To Recovery Keys To Recovery Alberta Health Services Bridgeland & Ophelia Supportive Housing Agency Program Alpha House Madison Francis Manor Sunalta Lodging House Aurora Women’s Housing Program The Alex Abbeydale Place Prelude Accessible Housing Newbridge CASS Stepping Stone Manor Langin Place YW of Calgary Providence Croydon Sharp Foundation Murrary’s House TBD The Maple * Opening 2018 Agency Program The Alex Pathways to Housing Total $: 0 Total $: 1,415,000 Total $: 904,000 Total $: 4,169,000 Total $: 0 Total $: 12,332,000 Total $: 10,292,000 Total $: 5,187,000 # of Clients: N/A # of Clients: N/A # of Clients: N/A # of Clients: 476 # of Clients: 0 # of Clients: 784 # of Clients: 310 # of Clients: 200 Cost/Client: N/A Cost/Client: N/A Cost/Client: N/A Cost/Client: $8,758 Cost/Client: N/A Cost/Client: $15,730 Cost/Client: $33,200 Cost/Client: $25,935 30.A.2 Packet Pg. 862 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Updated: 31 August 2018 Adults Sector 74% Youth Sector 10% Families Sector 14% System-Level Priorities 2% 30.A.2 Packet Pg. 863 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Updated: 31 August 2018 Defined as: Prevention Services provide short term financial assistance and limited case management in order to prevent housing loss due to a housing crisis. Defined as: Outreach involves moving outside the walls of the agency to engage people experiencing homelessness who may be disconnected and alienated not only from mainstream services and supports, but from the services targeting homeless persons as well. Defined as: System-Level Priorities are unique and diverse programs which provide support to the greater Homeless Serving System of Care. Non-Market Housing Defined as: Non-market housing is typically described as subsidized, social or affordable housing units. Grad Rent Subsidy Defined as: GRS is a rent supplement program that provides financial assistance for clients to obtain and maintain affordable housing after completion of a support program. Defined as: Adaptive Case Management programs offer client directed, flexible supports and financial assistance to those experiencing homelessness, to secure and sustain housing. Defined as: Supportive Housing (SH) provides case management and housing supports to individuals and families who are considered mid to high acuity. In this program type, the goal for the client is that over time and with case management support, the client(s) will be able to achieve housing stability and independence. Defined as: Permanent Supportive Housing (PSH) provides long term housing and support with no time limit for high acuity individuals experiencing major barriers and exhibiting complex needs, and who will require ongoing support to maintain their housing. Defined as: ACT is an integrated team-based approach designed to provide comprehensive community-based supports to help people remain stably housed. These teams may consist of physicians and other health care provides, social workers and peer support workers. Agency Program Agency Program Boys and Girls Club Unity Project McMan Rapid Rehousing Agency Program Wood’s Exit Reach Agency Program Distress Centre of Calgary CAA Team at SORCe Aboriginal Friendship Centre Indigenous Gathering Place Keys to Recovery Creation Lodge Keys to Recovery ASCHH Liaison Canadian Accreditation Council Accreditation Agency Program Agency Program Agency Program Boys and Girls Club Aura Infinity Project Home Fire Calgary John Howard Roofs for Youth McMan Hope Homes Hope Homes Aboriginal Woods New Horizon Agency Program Agency Program Total $: 171,000 Total $: 180,000 Total $: 904,000 Total $: 0 Total $: $0 Total $: 4,312,000 Total $: 0 Total $: 0 # of Clients: N/A # of Clients: N/A # of Clients: N/A # of Clients: N/A # of Clients: N/A # of Clients: 162 # of Clients: N/A # of Clients: N/A Cost/Client: N/A Cost/Client: N/A Cost/Client: N/A Cost/Client: N/A Cost/Client: N/A Cost/Client: $26,671 Cost/Client: N/A Cost/Client: N/A 30.A.2 Packet Pg. 864 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Updated: 31 August 2018 Defined as: Prevention Services provide short term financial assistance and limited case management in order to prevent housing loss due to a housing crisis. Defined as: Outreach involves moving outside the walls of the agency to engage people experiencing homelessness who may be disconnected and alienated not only from mainstream services and supports, but from the services targeting homeless persons as well. Defined as: System-Level Priorities are unique and diverse programs which provide support to the greater Homeless Serving System of Care. Non-Market Housing Defined as: Non-market housing is typically described as subsidized, social or affordable housing units. Grad Rent Subsidy Defined as: GRS is a rent supplement program that provides financial assistance for clients to obtain and maintain affordable housing after completion of a support program. Defined as: Adaptive Case Management programs offer client directed, flexible supports and financial assistance to those experiencing homelessness, to secure and sustain housing. Defined as: Supportive Housing (SH) provides case management and housing supports to individuals and families who are considered mid to high acuity. In this program type, the goal for the client is that over time and with case management support, the client(s) will be able to achieve housing stability and independence. Defined as: Permanent Supportive Housing (PSH) provides long term housing and support with no time limit for high acuity individuals experiencing major barriers and exhibiting complex needs, and who will require ongoing support to maintain their housing. Defined as: ACT is an integrated team-based approach designed to provide comprehensive community-based supports to help people remain stably housed. These teams may consist of physicians and other health care provides, social workers and peer support workers. Agency Program Aspen Family Home Stay Children’s Cottage Society HomeBridge Children’s Cottage Society Rapid Rehousing Agency Program Agency Program Distress Centre of Calgary CAA Team at SORCe Aboriginal Friendship Centre Indigenous Gathering Place Keys to Recovery Creation Lodge Keys to Recovery ASCHH Liaison Canadian Accreditation Council Accreditation Agency Program Agency Program Children’s Cottage Fee for Service Closer to Home Fee for Service CUPS Fee for Service Discovery House Fee for Service Inn From The Cold Fee for Service **No target # of clients for Fee for Service programs Agency Program Aspen Family Sustainable Families Children’s Cottage HomeLinks Discovery House Community Housing Inn from the Cold Housing with Intensive Supports Inn From The Cold Journey House 1 Journey House 2 Metis Calgary Family Services Rainbow Lodge Agency Program Agency Program Total $: 1,051,000 Total $: 0 Total $: 904,000 Total $: 0 Total $: 1,141,000 Total $: 4,428,000 Total $: 0 Total $: 0 # of Clients: N/A # of Clients: N/A # of Clients: N/A # of Clients: N/A # of Clients: 20** # of Clients: 254 # of Clients: N/A # of Clients: N/A Cost/Client: N/A Cost/Client: N/A Cost/Client: N/A Cost/Client: N/A Cost/Client: N/A Cost/Client: $17,433 Cost/Client: N/A Cost/Client: N/A 30.A.2 Packet Pg. 865 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc TogetherToZero Charting Calgary’s Path To the End of HomelessnessDecember 2018 Absolute Functional 30.A.2 Packet Pg. 866 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc The lead author of the Living Legacy Collective Impact Report & “Together to Zero” strategic directives was Alina Turner of Turner Strategies, in collaboration with I Heart Home, Calgary Homeless Foundation and the many agencies within Calgary’s Homeless-Serving System of Care AUTHORS: Dr. Alina Turner - Turner Strategies Victoria Ballance, Joel Sinclair - Calgary Homeless Foundation ENGAGEMENT TEAM: Nancy Loraas - Next Level Leadership Emily Bedford, Megan Donnelly - I Heart Home, Calgary Homeless Foundation INDIGENOUS ENGAGEMENT TEAM: Karen Pheasant-Neganigwane Ange Neil Katelyn Lucas - Aboriginal Standing Committee on Housing and Homelessness 30.A.2 Packet Pg. 867 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc ”“Coming together is a beginning. Keeping together is a progress. Working together is success. - Henry Ford ”“Individual commitment to a group effort - that is what makes a team work, a company work, a society work, a civilization work. - Vince Lombardi 30.A.2 Packet Pg. 868 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Acknowledgements WE WOULD LIKE TO EXPRESS OUR DEEP APPRECIATION TO ALL THOSE WHO MADE THIS DOCUMENT A POSSIBILITY. FIRST AND FOREMOST, OUR SINCERE GRATITUDE GOES OUT TO EVERY FRONT LINE WORKER WHO ATTENDED OUR ENGAGEMENT SESSIONS AND OFFERED THEIR STORIES WITH RESPECT, TRUST, AND VULNERABILITY. THESE STRATEGIC DIRECTIVES WOULD NOT BE POSSIBLE WITHOUT THEIR WILLINGNESS TO BELIEVE IN A FUTURE WITHOUT HOMELESSNESS IN OUR CITY, AND THE COURAGE THEY HAVE TO DEDICATE THEIR LIVES TO MAKING IT A REALITY. IT WAS A GREAT PRIVILEGE FOR US TO CAPTURE THEIR STORIES, THOUGHTS AND IDEAS, WHICH ALLOWS US ALL TO ADVANCE UPON OUR PRACTICES TO CONTINUALLY IMPROVE OUR SERVICE TO THOSE WHO ARE EXPERIENCING HOMELESSNESS. We would also like to thank the Government of Canada, the Government of Alberta, and City of Calgary for their unprecedented support for our collective mission and their substantial contributions to capital projects and programs which have allowed us to demonstrate tremendous success and arrive at the place we are today. We also want to thank Indigenous Elders, Chiefs and Council, leaders and individuals who continually inform us to ensure we are culturally inclusive, and for always providing their truth and wisdom through honesty and vulnerability. We thank those with lived and living experience of homelessness who share their stories, opinions and thoughts, and consistently give of themselves to help us craft a system of care that is focused on people first and meeting the needs of those we serve. Many thanks to all Calgarians who volunteer, educate and participate in our collective vision of ending homelessness by gifting us with their time, talents and resources. A vision toend homelessness in Calgarycan only be achieved, together. 30.A.2 Packet Pg. 869 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Our Consultation Process TO MARK THE CONCLUSION OF CALGARY’S 10 YEAR PLAN TO END HOMELESSNESS, MEMBERS OF CALGARY’S HOMELESS-SERVING SYSTEM OF CARE (HSSC) AS WELL AS BROADER STAKEHOLDER GROUPS (PUBLIC, CORPORATE CALGARY, THOSE WITH LIVED EXPERIENCE OF HOMELESSNESS, INDIGENOUS ELDERS, YOUTH AND ADULTS) WERE INVITED TO GIVE REFLECTIONS ON THE PAST DECADE OF ENDING HOMELESSNESS IN OUR CITY IN ORDER TO INFORM HSSC DIRECTIVES MOVING FORWARD. Phase I of this engagement process involved 54 long-standing individuals within the HSSC who had extensive knowledge of Calgary’s 10 Year Plan to End Homelessness. The purpose of these sessions was to identify the key topics to bring to discussions with the broader community. These discussions focused on the following questions: z What’s working? z What’s not working? z What unique factors made this possible? z What’s most important? z Is there anything we’re missing or that we should be asking? Discussions within the first phase sessions identified eight key topic areas to explore in Phase II of the engagement process: 1. Caring for the Front Lines 2. Data and Reporting 3. Empowering Calgarians 4. Homeless-Serving System Planning 5. Housing 6. Poverty and Homelessness 7. Shelter Visioning 8. Empowering Calgarians: The Public Phase II called to all members of the HSSC, as well as broader stakeholder groups such as key members of the primary public systems, corporate Calgary, community volunteers, agency board members, agency executives, the public, and those with lived experience of homelessness to contribute their thoughts, stories, knowledge and opinions. Each session focused on one of the topics listed above, and Phase II saw 12 engagement sessions attended by over 200 participants for a total of 53 hours. In addition, 42 public online surveys were completed. All Phase I and II engagement sessions were facilitated by Nancy Loraas of Next Level Leadership. Remarks were collected in the form of minutes, written long-answer and short-answer forms, and online surveys. Separate and complementary sessions were completed with Indigenous Elders, leaders, youth, and adults many with current or past experience of homelessness. Elders were consulted first, and guided subsequent conversations as participants were invited to give their reflections on the unique perspective of Indigenous homelessness in Calgary. These sessions were led by Indigenous facilitators: Karen Pheasant-Neganigwane, Ange Neil and Katelyn Lucas. Honouring oral tradition, remarks from these sessions were collected through video and voice recording. The directives reflect feedback received throughout the consultation process and the quotes included in this report are a few of the remarks made by engagement session participants. 30.A.2 Packet Pg. 870 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Introduction:Together to Zero ON JANUARY 29, 2008, THE CITY OF CALGARY LAUNCHED A BOLD INITIATIVE TO END HOMELESSNESS IN OUR COMMUNITY. CALGARY’S 10 YEAR PLAN TO END HOMELESSNESS WAS FOUNDED ON THE ASPIRATIONAL GOAL OF ENDING HOMELESSNESS IN OUR CITY IN TEN YEARS. AS A FIRST OF ITS KIND IN CANADA, THE ORIGINAL VISION OF CALGARY’S 10 YEAR PLAN WAS THAT ALL PEOPLE FACING HOMELESSNESS IN CALGARY WILL HAVE ACCESS TO SAFE, DECENT AND AFFORDABLE HOUSING AS WELL AS THE RESOURCES AND SUPPORTS NECESSARY TO SUSTAIN THAT HOUSING BY THE YEAR 2018. While Calgary did not achieve its ambitious goal of ending homelessness, over the past decade our community has had many successes. We’ve housed almost 10,000 people, built almost 600 units of permanent housing with supports, and we’ve developed a well-coordinated homeless- serving system of care that the rest of the world consistently looks to emulate. Calgary is a leader in our country. Our city has consistently led the charge to end homelessness in Canada – and as we have collaborated and coordinated around Calgary’s 10 Year Plan, we have learned a lot. We have learned that Housing First does not equal housing only, and that many people may require wrap around supports to help them be successful. We have discovered that the true causes of homelessness come from external macro factors, and that prevention must predominantly occur in the primary public systems. We have created a Homeless Management Information System (HMIS) that allows us to better assess the state of homelessness in our city, and we have also learned that while the goal of a true Absolute Zero end to homelessness remains our collective aspirational goal we realize that this is not realistic in practice without significant changes within our primary systems. It makes more sense for us to focus on achieving what is now known as Functional Zero - whereby efforts are concentrated on reaching a point where there are enough services, housing and emergency shelter beds for everyone who needs them. This way, anyone who does experience homelessness does so only briefly, is rehoused quickly and successfully, and is unlikely to return to homelessness again. Functional Zero is a realistic and achievable goal in our city, if we all work together. This guiding document is a consolidation of a decade of knowledge combined with what we, as a community, envision as the primary strategic areas of focus crucial to achieving this collective goal. Through our Living Legacy engagement sessions participants clearly articulated what they felt are the most critical areas of focus for our city. Their collective knowledge directly informed the creation of the six core Strategic Directives within this guiding document that will take us Together to Zero. These six Strategic Directives provide an intentional framework by which public systems, homeless-serving agencies, the public, corporate Calgary, and partners, can best utilize the shared knowledge gained over the last ten years to adjust and align our individual agencies’ strategic and tactical plans, governance models, initiatives, and programs to function better within the Homeless-Serving System of Care (HSSC) in order to best meet the needs of vulnerable Calgarians who are at risk of or experiencing homelessness. While stopping homelessness before it ever begins will always be our shared goal, collectively aligning ourselves with the Strategic Directives outlined within this guiding document will help Calgary to achieve Functional Zero and empower our community to continue charting our path forward to the end of homelessness in Calgary. Absolute Functional 30.A.2 Packet Pg. 871 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc CALGARY’S HOMELES S S ERVIN G S YSTEM OF CAREPrimary PublicSystems CHSSC - Default System Public systems: (Housing, Income Supports, Justice, Childrens’s Services, Health) The primary systems of care in our city. Though they are distinct, they integrate with each other in service to individuals. Calgary’s Homeless-Serving System of Care (CHSSC) is a default system. The not-for-profit agencies in the HSSC can, with appropriate and guaranteed resources, provide services (right connecting or direct) to clients who have fallen through fractures within primary public systems. Growing the HSSC will never solve the broader systemic issues that cause homelessness. Public systems invest in housing and supports and contribute resources to address the complex needs of clients experiencing homelessness. Intentional, systems-informed service oriented partnerships between primary public systems and not-for-profits (before homelessness occurs) optimizes ecosystem effectiveness. CHSSC focus is on achieving a point where there are enough services, housing and emergency shelter beds for everyone who needs them so that anyone who experiences homelessness does so only briefly, is rehoused quickly and successfully, and is unlikely to return to homelessness again. 1 2 4 3 Primary prevention occurs within the primary public systems. CHSSC Catches those who fall through fractures within the primary systems. If a client presents within the HSSC, primary prevention is no longer possible. CHSSC reconnects clients back to the primary systems whenever possible. 5 1 2 3 5 What isFunctional Zero? OVER THE PAST DECADE WE’VE LEARNED THAT WE REQUIRE A MORE AGILE SYSTEM, AND CONCURRENTLY, WE NEED A MORE AGILE VISION OF SUCCESS. THE MOVE AWAY FROM FIXED-POINT TARGETS TO INDICATORS OF PROGRESS ENABLED US TO THINK ABOUT SUCCESS IN A DIFFERENT WAY, AND WE NOW FRAME SUCCESS IN TERMS OF FUNCTIONAL ZERO. A Functional Zero end to homelessness means that public systems and the HSSC have a systematic response in place that ensures homelessness is prevented whenever possible or is otherwise a rare, brief, and non-recurring experience. Functional Zero for Calgary does not mean that no one will ever experience homelessness but, rather, as a system of care (public and HSSC) we will have the resources that allow us to measure the capacity, sustainability, and effectiveness of our system in real time. This, in turn, allows us to ensure that our focus is on reconnecting clients to the appropriate public systems and achieving a point where there are enough services, housing, and emergency shelter beds for everyone who needs them so that anyone who experiences homelessness does so only briefly, is rehoused quickly and successfully, and is unlikely to return to homelessness again. It also means that as a community, we have absolute zero tolerance for ignoring homelessness, normalizing it, doing nothing to prevent it, and doing nothing to stop it. Functional Zerofor Calgary: 30.A.2 Packet Pg. 872 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 1PEOPLE FIRST OF PRIMARY CONSIDERATION FOR ANY FUTURE EFFORTS, THE HSSC MUST REMAIN GROUNDED IN A PEOPLE-FIRST APPROACH. THIS MEANS THAT WE MUST CONTINUALLY REMIND OURSELVES THAT WHILE WE EXIST TO SERVE THOSE MOST VULNERABLE, WE MUST ALSO BE MINDFUL OF ALL WHO ARE INVOLVED IN OUR EFFORTS TO PREVENT AND END HOMELESSNESS IN OUR CITY.STRATEGIC DIRECTIVE30.A.2 Packet Pg. 873 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc ”“ The Voice ofLiving and Lived Experience The Homeless Charter of Rights is empowering. It’s helping leaders understand what they need to support what people are going through, and it’s what will empower people experiencing homelessness when they are in public. It is clear that more can be done to diminish the gap between the recipients of our services and those who deliver and fund those services. We have long lamented the lack of service user input in program design – yet have only begun to implement measures that circumvent service-centric systems. Moving forward, we need to explore the potential of a culture of innovation with the voice of people with lived experience at its core. Embedding their input at key points in the program development-delivery continuum will enable and facilitate an iterative improvement process that allows the HSSC to better meet the needs of clients. IN 2015, CALGARY’S PLAN WAS UPDATED WITH A PEOPLE FIRST LENS, WHICH MEANS THAT WE MEET THOSE AT RISK OF, OR EXPERIENCING HOMELESSNESS WHERE THEY ARE, AND ALLOW THEM TO MAKE THEIR OWN CHOICES FOR SERVICES AND HOUSING. AT ITS CORE, WE MUST CONTINUE TO FOCUS OUR EFFORTS AROUND ALLOWING THE VOICE OF LIVED AND LIVING EXPERIENCE TO CONSTANTLY INFORM THE WORK THAT WE DO. WHAT THIS ULTIMATELY MEANS IS THAT WE MUST CONTINUALLY LISTEN AT THE SERVICE LEVEL WHILE CONSISTENTLY SEEKING INPUT AT THE PROGRAMMATIC LEVEL. 30.A.2 Packet Pg. 874 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc “”Action on Truth & Reconciliation:The Effects of Colonization &Recognition of Cultural Differences I think right at this point, what it means to be Indigenous is that we’re all recovering. Maybe not necessarily from addiction but we are recovering from our own misery. And that has yet to be recognized as society, as a whole, or even acknowledged. ENDING HOMELESSNESS IN CALGARY MUST ADDRESS THE HISTORY AND IMPACT OF COLONIZATION THAT IS A PRIMARY DRIVER OF HOMELESSNESS FOR INDIGENOUS PEOPLE, AND EFFORTS WILL ONLY BE EFFECTIVE WITH THE LEADERSHIP OF, AND AUTHENTIC PARTNERSHIPS WITH, INDIGENOUS PEOPLES IN OUR COMMUNITY. THE TREMENDOUS OVERREPRESENTATION OF INDIGENOUS PEOPLE AMONGST MARGINALIZED GROUPS, INCLUDING THOSE EXPERIENCING HOMELESSNESS, CLEARLY INDICATES THE ONGOING EFFECTS OF COLONIALIZATION. THE IMPACTS OF RESIDENTIAL SCHOOLING, THE SIXTIES SCOOP, AND ONGOING RACISM CONTRIBUTE TO FURTHER INTERGENERATIONAL TRAUMA COMPOUNDING ITS EFFECTS ON INDIGENOUS PEOPLE’S HEALTH AND WELLBEING. Truth must inform reconciliation. This is not a check box exercise. A renewed focus on building partnerships and nurturing trust with First Nations is a crucial next step – as is building partnerships with Inuit and Métis communities. In support of this process, Indigenous Elders, youth and adults with lived experience provided specific feedback into the strategic directive development process to facilitate a better understanding of homelessness from an Indigenous perspective. Many Indigenous Elders attributed the core issues that contribute to homelessness in the Indigenous community to the intergenerational trauma caused by residential schools and colonization; a loss of connection to family, community and culture – including language, traditional values, spirituality and ceremony; as well as a lack of appropriate housing and government funding to create additional housing that is required on the reserves. Indigenous Elders also discussed the high occurrence of addiction to drugs and alcohol and prevalence of domestic violence. Many also highlighted that stereotypes still exist and that often this stems from a lack of understanding and knowledge of history and culture. The Elders shared their view that the younger generations have lost their parenting skills as many 30.A.2 Packet Pg. 875 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc of them are repeating the parenting techniques learned within the residential school system. These parenting techniques are believed to be contributing to the continued cycle of abuse and trauma, and elder generations (typically grandparent figures) have had to step in to raise grandchildren in a healthy and traditional way to bridge the knowledge gap within the younger generations’ lack of parenting skills. Addiction for many is linked to a lack of connection and access to cultural engagement, specifically to history, language, land, traditions, ceremony and community. It was also noted that Indigenous peoples have an “identity problem.” This stems from being disconnected from their community and traditional culture, which contributes to a lack of acceptance of their heritage and a diminished feeling of pride and self-worth. Indigenous self-determination is core to truth and reconciliation and must underpin the development of homelessness programs and strategies. Further, the urban Indigenous community is non-homogenous and there is a diversity of Indigenous culture. This means rather than “Indigenizing” programs, we must participate in meaningful engagement and co-development processes with Indigenous partners in Calgary and Alberta. The HSSC must continue to explore, in partnership with Indigenous governments and partners, what role the HSSC should play in support of self-determination. Such reflection will need to be a key priority post-2018 as we work together to solve the homelessness crisis affecting Indigenous people. “” I’m intimidated going into a room full of white people even if it’s all about recovery. I understand that comfort level with our own people, and that we need to be around our own people to heal. 30.A.2 Packet Pg. 876 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc The challenges of working with high-complexity individuals experiencing homelessness continues to negatively impact our front line workers. The psychological stressors, and/or vicarious trauma of working with clients who have or are experiencing trauma, addictions and mental illness combined with the physical and environmental challenges factor into everyday life for those working on the front lines. Our staff are the primary advocates for those they serve, however, the burden on staff working with complex populations continues to take its toll. In a CHF-commissioned study interviewing 245 staff in 13 agencies, Drs. Wagemakers Schiff and Lane (2016) assessed burnout and post-traumatic stress in Calgary’s homeless-serving sector. The study points out that a disproportionate number of front line workers have minimal education and training for dealing with the complexity of the clients they are serving. Many staff have no training in counselling or intervention skills (particularly in addictions) prior to being hired into these critical front line positions. According to the study, about 25% of workers in the homeless-serving sector in Calgary suffer from burnout and compassion fatigue that heavily impacts job performance and decreases their quality of life. Further, approximately 36% of those interviewed reported symptoms that would very likely result in a PTSD diagnosis. This vicarious traumatization is likely the result of a combination of prior traumatic experiences, traumatic work events, and being witness to client trauma. This sentiment was reflected in our engagement sessions with participants stating that their jobs are constantly crisis-driven, which is highly stressful, and HSSC front line staff suggested a number of possible ideas to better support them in their work. They did reflect that collaboration among agencies was beneficial for their work life and that the strong sense of community within and among agencies is beneficial for their mental health. Individuals in supervisory roles acknowledged that more leadership training would also be highly beneficial, but also strongly suggested safer and more effective channels for front line staff to express concerns and feedback to leadership and executive levels within their respective organizations. Front line workers also expressed that peer-to-peer support, mentorship and talking with others who have had similar experiences is much more effective than third party counselling, and while front line staff recognized that existing training (such as the vicarious trauma workshops) was beneficial to ongoing work, there was an overall acknowledgement that gaps still remained. Beyond 2018, leaders within the HSSC must review working conditions, professional capacity building, and training needs to meaningfully support those on the front line who are doing the extraordinarily difficult work. Caring for the Front Lines ONE OF THE MOST CONSISTENT THEMES THAT FLOWED THROUGH OUR ENGAGEMENT SESSIONS IS THAT OUR FRONT LINE WORKERS FEEL NEGLECTED AND WITHOUT SUPPORT. THROUGHOUT THE FEEDBACK PROCESS, IT CONSISTENTLY BECAME CLEAR WE NEED TO BEGIN TO GIVE THE SAME LEVEL OF ATTENTION AND CARE TO OUR OWN PEOPLE AS WE GIVE TO THOSE WE SERVE. ”“One of the challenges is often that we work in an environment that’s always crisis-driven and staff is under stress. The challenge is that we don’t turn around and acknowledge that and put resources in place that mitigate the crisis component. We don’t turn our mission for clients around on ourselves. 30.A.2 Packet Pg. 877 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Living and Lived Experience: z Enhance client-centered lens by integrating client feedback intentionally through program development, implementation, and evolution. z Continue to leverage the voice of lived experience by listening to people, committees and groups such as the Client Action Committee and Youth Advisory Table, and allow their input to consistently inform the work that we do. z Intentionally seek out those living in homelessness to be more responsive to real- time needs as their experiences are time, system, and landscape dependent. Caring for the front lines: z Review opportunities to enhance training and peer-to-peer supports to augment frontline staff capacity. z Examine and create more opportunities for front line worker concerns and feedback within homeless-serving organizations and throughout the greater system of care. z Continue collaborating and fostering a greater sense of community between and among agencies within the HSSC. Action on Truth and Reconciliation: z Stop “Indigenizing” programs and start right connecting to existing Indigenous communities and services to foster greater self-determination and participate in meaningful engagement and co-development processes with Indigenous partners within Calgary and Alberta. z Seek guidance from Indigenous Elders and partners to increase awareness of culture and intergenerational trauma and their impact on people, structures, and policies within HSSC agencies and organizations. z Respectfully incorporate Indigenous ways of knowing, oral tradition, ceremony, acknowledgement, and history into more culturally-appropriate service delivery. People First Priority Areas of Focus: 30.A.2 Packet Pg. 878 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2 HOME FOR EVERYONE OVER THE PAST DECADE THE HSSC HAS BECOME MUCH MORE ADAPTABLE AS IT’S SHIFTED TO MEET CLIENTS’ NEEDS. HOWEVER, INCREASED FLEXIBILITY IS REQUIRED WHEN IT COMES TO THE HOUSING CONTINUUM IN ORDER TO MAINTAIN THIS CLIENT-CENTERED LENS. HOUSING FIRST IS NOT HOUSING ONLY, AND HOUSING CAPACITY AND DESIGN MUST BE IN ALIGNMENT WITH THE DIVERSE NEEDS OF THE INDIVIDUALS WE SERVE.STRATEGIC DIRECTIVE30.A.2 Packet Pg. 879 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc HousingFirst Chronic health issues, (particularly mental illness, disabilities, and physical illness), increase risk for homelessness. Those experiencing housing instability often face a multitude of challenges – including mental health issues, addictions, domestic violence, limited education, barriers to employment, and involvement with multiple systems like Children’s Services and Justice. Housing First works for people, public systems, and communities by delivering access to housing with wrap around supports. However, Housing First is not housing only. It is a people-centric approach that recognizes the unique needs of individuals and families, as housing and programs need to be adaptable and reflective of the changing dynamics of individuals and families experiencing homelessness. Over the past decade the sector has primarily prioritized high-complexity clients, ensuring that limited resources were strategically utilized. We now recognize that housing and programming must be made available for mid-complexity clients as an intervention and prevention measure. The current housing continuum does not capture the differing needs within different program types and it has been expressed that a more comprehensive definition of “success” within a Housing First model is required as clients often found a space that they like and simply elected to stay there. We also need to examine opportunities to further incorporate an Indigenous lens into our housing strategies – such as providing multi-family dwellings with programming that promotes healing, community and culture. A key learning over the past decade revealed that, while there are pieces of the service network that the non-profit sector can deliver more effectively and cost- efficiently on behalf of mainstream systems, it can only do so with adequate resourcing and collaboration to achieve ongoing system coordination. The lack of capacity and access to public services such as counseling, mental health supports, and addictions services continue to be a key barrier for those experiencing homelessness. This is why we need other public systems to invest and operate in housing and supports as well – Health, Justice, Children’s Services, and others can contribute resources to address the complex needs of clients experiencing homelessness. For instance, the Collaborative for Health and Home (CHH) identified 900 complex, long-term homeless individuals who are in need of an integrated health and housing response as result of their complex mental health, addiction, and physical health challenges. The HSSC does not have the capacity, the expertise, nor the authority to build and operate such a facility; we need Alberta Health’s leadership to address this need. Similarly, correctional facilities require additional community-based housing units and supports appropriate to the levels of need of the person released. Provincial and federal corrections systems must contribute to the development of housing stock and supports specific to the needs of shared complex service participants with housing instability. Youth leaving provincial foster care also need transition supports, including rent subsidies and access to affordable housing. The HSSC can be a part of all of these solutions, however, it cannot be expected to take them on alone. CALGARY’S 10 YEAR PLAN WAS BUILT UPON THE PHILOSOPHY OF HOUSING FIRST. VERY EARLY ON, WE UNDERSTOOD THE NOTION OF HOUSING FIRST AS THE IDEA OF PROVIDING A PERSON EXPERIENCING HOMELESSNESS WITH HOUSING, WHILE SIMULTANEOUSLY OFFERING THEM SUPPORTS TO ADDRESS COEXISTING ISSUES THEY MAY BE FACING. “” Housing First wasn’t in our philosophy 10 years ago. The person-centered supports are amazing, but it was disruptive to the system. 30.A.2 Packet Pg. 880 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Intensity of Support Non-market housing Market housing Level of Subsidy Level of Income No Housing EmergencyTransitional Housing Supportive CareHousing Non-Market Housing(Rental and Ownership)Market Housing(Rental and Ownership) Calgary’s Housing Continuum Calgary’s Community Housing Affordability Collective (CHAC) represents an important first step for a sector that needs to advance its collaborative work towards an integrated and coordinated approach to better meet the community’s needs. Enhancing the coordination of the housing continuum with the homeless-serving system of care will further ensure a seamless integration of these resources for clients at risk of or experiencing homelessness. Moving forward, addressing the unique needs of diverse groups will continue to be a priority at the program and system levels. Adding much needed affordable housing stock will meet the needs of some individuals, however other individuals experiencing homelessness will require long-term housing with on- site intensive supports delivered through supportive housing models with integrated public health care. Accordingly, housing units and program design will need to be built across the housing spectrum in alignment with the diverse needs of the individuals we serve. Finally, all citizens of Calgary should have a safe, secure, affordable and well-maintained home from which to realize their full potential and be contributing members of our community. Marginalized persons, such as those exiting homelessness, have the right to be protected from discriminatory practices which limit their housing opportunities. This view aligns with the recently released National Housing Strategy which declared “housing rights are human rights.” Applying a human rights based framework that fosters participation, inclusion and non-discrimination must be prioritized by all orders of government, with municipal leadership being critical. The Housing Continuum A SHORTAGE OF AVAILABLE AFFORDABLE HOUSING UNITS CONTINUES TO CREATE BOTTLENECKS AT ALL POINTS ON THE HOUSING CONTINUUM AS CALGARIANS STRUGGLE TO MOVE FROM TRANSITIONAL TO PERMANENT HOUSING, FROM NON-MARKET TO MARKET RENTAL HOUSING, OR FROM RENTAL HOUSING TO HOME OWNERSHIP. THE PRIVATE SECTOR IS ALSO A KEY PARTNER IN THIS EFFORT, AND WE WILL CONTINUE TO NEED THEM TO DEVELOP AFFORDABLE HOUSING OPTIONS AND WORK WITH THE NON-MARKET HOUSING SECTOR TO ENHANCE ACCESS TO AVAILABLE STOCK. WE WILL ALSO NEED TO WORK IN PARTNERSHIP WITH OUR AFFORDABLE HOUSING PROVIDERS TO EXPLORE NEW DELIVERY MECHANISMS THAT ARE FLEXIBLE AND INNOVATIVE. City of Calgary Affordable Housing Strategy http://www.calgary.ca/CS/OLSH/Documents/Affordable-housing/Corporate-Affordable-Housing-Strategy.pdf 30.A.2 Packet Pg. 881 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Housing First: z Continue to focus on refining, perfecting, and adapting the Housing First model to maintain and improve our client-centric approach. z Examine opportunities to further incorporate an Indigenous lens into our Housing First strategies. z Increase housing sustainability by focusing our efforts on utilizing strengths-based approaches to fostering client resiliency and to empowering clients to optimize and/ or build natural supports, thus becoming less reliant on systems supports. The Housing Continuum: z Work with all orders of government leadership (Federal, Provincial, Municipal, Indigenous) to develop policies that increase affordable housing options and apply a human rights based framework that fosters participation, inclusion and non- discrimination. Considerable efforts have more recently emerged at all orders, which is encouraging. z Engage the private sector as a key partner in this effort. We will continue to need them to help develop affordable housing options and work with the non-market housing sector to enhance access to available stock. z Work with affordable housing partners to leverage common assets, becoming increasingly innovative in our collective work. Home For Everyone Priority Areas of Focus: 30.A.2 Packet Pg. 882 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 3 DATA AND KNOWLEDGE WE HAVE A CRITICAL BLIND SPOT IN OUR CAPACITY TO END HOMELESSNESS DUE TO THE LACK OF DATA INTEGRATION THROUGHOUT AND BETWEEN THE HSSC AND THE PRIMARY PUBLIC SYSTEMS OF CARE. IN THIS SENSE, WE DO NOT HAVE ENOUGH VISIBILITY IN THE FULL SCALE AND DYNAMICS OF THE ECOSYSTEM INVOLVED. MEASURING AND MONITORING SUCCESS REQUIRES A REAL TIME, SYSTEM-LEVEL LENS AND, DESPITE PROGRESS, A TRUE INFORMATION SYSTEM THAT TIES TOGETHER ALL SERVICES WITHIN THE ECOSYSTEM CURRENTLY DOES NOT EXIST IN CALGARY.STRATEGIC DIRECTIVE30.A.2 Packet Pg. 883 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Research & Real-TimeKnowledge Dissemination However, even though we recognize the importance of data in developing agile responses to social issues, we are still working on the creation of an integrated ecosystem that truly closes the gap between evidence and practice. We need to increase our capacity to respond to emerging and current requirements. Given that as many as 10,000 services exist in the Calgary ecosystem it is essential that we map this complexity and monitor its trends and outcomes. Access to real time data from a larger network of services can drive agile system planning and help link all agencies within the HSSC together through our shared mandate. We also know that sustaining an end to homelessness requires the coordination of the entire HSSC in partnership with the primary public systems, and advancing solutions in policy, interventions, and research will continue to be required to inform decision making. IN ORDER TO ACHIEVE FUNCTIONAL ZERO, IT IS IMPERATIVE THAT WE DEVELOP A SYSTEM THAT LEVERAGES REAL TIME DATA. USING DATA TO INFORM RESEARCH (WHICH IN TURN INFORMS PRACTICE) HAS ENABLED US TO BETTER TAILOR INTERVENTIONS THAT MEET THE NEEDS OF DIVERSE CLIENTS AND ASSESS THE EFFICACY AND EFFICIENCY OF SERVICES IN ORDER TO ENHANCE AND IMPROVE CLIENT OUTCOMES. DataSharing We also know that our capacity to end homelessness relies on greater data integration between the HSSC and primary public systems such as Children’s Services, Health, and Justice. This existing data disconnect results in having no way of knowing whether new service participants are coming into the system as a whole, or if they are cycling through various components. This hampers system planning and in turn, our capacity to respond appropriately and adjust in real time. In order to move system planning forward, efforts to enhance coordinated service delivery are critical, and this includes having better visibility into all components within the system. The ability of service providers, multi-disciplinary teams, police officers and health professionals to respond in the most appropriate and beneficial manner to individuals in need also requires appropriate information sharing, and we will need to resolve this lack of integration if we are to move forward and enhance coordinated service delivery across systems, rather than simply within our own. WE’VE MADE GREAT STRIDES OVER THE LAST DECADE IN TERMS OF DATA COLLECTION AND UTILIZATION, AND WHILE WE HAVE FOUND THAT THE INCREASE IN DATA SHARING THROUGHOUT THE HSSC IS HIGHLY BENEFICIAL, WE STILL NEED TO DEVELOP NEW TECHNOLOGICAL SOLUTIONS TO SUPPORT MORE SEAMLESS DATA INTEGRATION ACROSS THE HSSC AND PRIMARY PUBLIC SYSTEMS. 30.A.2 Packet Pg. 884 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Key Performance Metrics Current KPIs are limited to measuring program performance within the HSSC, and while this is crucial for monitoring the efficacy of Housing First programs themselves, they don’t capture the interaction between funded and non-funded agencies (shelters in particular). Our progress over the recent years has illustrated that system-level KPIs will need to be developed to measure alignment and coordination across the entire HSSC and into the public systems. While the HSSC has developed and continues to refine our KPIs at a program level, it is essential that our performance management approach becomes more agile and able to inform adjustments in real time as part of a comprehensive approach that tackles the structural, systemic, community, institutional, interpersonal, and individual causes of homelessness. Moving forward we need to identify and start measuring system-level indicators in order to be more nimble in our planning and become more proactive in our collective response. Measurement Tools As we work towards our goals, we require a way to measure our success. Historically, our HSSC has relied on tools such as our biennial Point in Time Counts (PiT) to measure the current state of progress. PiT counts are important for identifying trends but they only provide a snapshot of homelessness within a specific time period and are, therefore, of limited value as a lagging indicator. We need to develop more agile system planning mechanisms that effectively track inflow and outflow in real time, while providing an accurate picture of what is happening across services in terms of participant needs and outcomes. Future work in this area must focus on developing and implementing measurement tools, such as the Scope of Needs and Services List (Calgary’s version of a By Names List) that allows us to have a real-time and more holistic snapshot of people experiencing homelessness along with their needs and the services that they require. These types of real time data tools are better equipped to capture the flow of individuals entering and exiting the HSSC, and allow us to better serve them by right connecting them to public systems or services, thus ending their experience of homelessness as quickly as possible. Measurement UTILIZING EVIDENCE-BASED BEST PRACTICES, KEY PERFORMANCE INDICATORS (KPIS) ENABLE US TO BUILD A HIGH-PERFORMING SYSTEM OF CARE THAT STABLY HOUSES THOSE WHO ARE EXPERIENCING CHRONIC AND EPISODIC HOMELESSNESS, AND ALLOWS US TO BE MORE RESPONSIVE TO CALGARY’S UNIQUE NEEDS. ”“To measure impact, we have our agency impact, but as a system, what is the goal? Is it the systems impact or our program impact? The system impact needs to be something that agencies can actually measure within their programs. That’s not happening right now. ”“I like the data sharing idea – one system, or more than one, integrated and accessible by different programs. You automatically build tighter community. 30.A.2 Packet Pg. 885 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Data Sharing: z Maintain client autonomy and privacy while improving agency and program collaboration. Use client-centered language to educate clients on their right to privacy, and give them a comprehensive understanding of how data sharing meets their needs, why their data is being collected, who can see it, and how it is being used. z Increase data sharing commitments and agreements by all agencies within the HSSC and the primary public systems of care. z Investigate and examine technological solutions to support data integration within and between the HSSC and primary public systems of care. z Enhance system of care visibility. Ongoing efforts to enhance coordinated service delivery are critical; this includes having enhanced visibility of all components of the system. We need to develop workable and effective solutions in support of information sharing provisions and protocols. Measurement: z Develop and adhere to systems-level performance indicators to inform real time systemic adjustments as part of a comprehensive approach that incorporates the structural, systemic, community, institutional, interpersonal, and individual causes of homelessness. z Integrate a Scope of Needs and Services List that enables the HSSC to have a real time snapshot of the needs of, and services required by, the individuals we serve. Research & Real-Time Knowledge Dissemination: z Examine system mapping to enable real time, full visibility of all services and agencies to all organizations within the HSSC. z Provide access to real time, actionable data to drive agile system planning in order to link all agencies within the HSSC into a cohesive system of care through our common shared mandate. Data and Knowledge Priority Areas of Focus: 30.A.2 Packet Pg. 886 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 4 AGILE HSSCPLANNING STRATEGIC DIRECTIVEAGILE SYSTEM PLANNING IS ABOUT MORE THAN SETTING TARGETS AND MONITORING PERFORMANCE. AN AGILE SYSTEM WOULD BEGIN WITH PREVENTION WITH A FOCUS ON BEING RESPONSIVE, NOT REACTIVE. FASTER, AND MORE STRATEGIC CYCLES OF DEVELOPMENT ARE NEEDED THROUGHOUT THE HSSC, NOT ONLY IN THE PROGRAM IMPLEMENTATION, BUT ALSO IN WORKING ALONGSIDE PRIMARY PUBLIC SYSTEMS. 30.A.2 Packet Pg. 887 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc AGILE HSSCPLANNING SystemCoordination At a programmatic level, and as the HSSC continues to advance (and the capacity of the system to deliver on client-centered outcomes related to housing referrals, housing placement and housing stability evolves) it is critical that we are measuring the right things and integrating what we learn into our agency-specific service delivery plans. As our community becomes increasingly data-driven, comparison and evaluation are major mechanisms for systems improvement, decision making and planning. Data, measurement and reporting doesn’t always effectively capture progress made with clients – or alternatively, areas of concern. For example, there needs to be a better understanding of rehoused placements and the instances of Housing First graduates coming back into the system. Moving forward, a review and refinement of the indicators used to assess program performance will be important. This will need to be an iterative process that ensures program KPIs align with on-the- ground experiences of the front line. Finally, we know that sustaining Functional Zero requires the coordination of the entire HSSC in partnership with primary public systems, and advancing solutions in policy, interventions, and research will continue to be needed. As shifts in our environment impact homelessness we need to course- correct in real time to ensure effectiveness, and as we relieve the current backlog in our system we can work with public systems to shift public system resources to enhance our focus on prevention, and move upstream to address the root causes of homelessness in a coordinated manner. Accordingly, the HSSC can play a critical role in creating service delivery models that right connect people to primary public systems and increase capacity and access to essential services for people at risk of or experiencing homelessness. A SYSTEM PLANNING APPROACH WITH A NEUTRAL BACKBONE SYSTEM PLANNER ORGANIZATION TO DRIVE COORDINATION, AND WHERE APPROPRIATE, INTEGRATION EFFORTS AMONG THE HSSC AND PUBLIC SYSTEM PARTNERS (SUCH AS HEALTH AND JUSTICE) WILL BE REQUIRED TO MAINTAIN FASTER, LEANER CYCLES OF DEVELOPMENT THROUGHOUT THE SYSTEM OF CARE. TO THAT END, AGILE HSSC PLANNING IS MORE THAN SETTING TARGETS AND MONITORING PERFORMANCE. IT REQUIRES A LEAD SYSTEM PLANNER ORGANIZATION TO DEVELOP A NIMBLE AND ITERATIVE APPROACH TO CONTINUAL IMPROVEMENT. ”“We do need more funding allocated to preventative work, but if we’re going to get into it, let’s think about accountability and not take on the work that other agencies and system can or are already doing better. 30.A.2 Packet Pg. 888 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc ”“We need to tailor the scorecards and benchmarks according to programs. What if we looked at a positive change in client complexity rather than agency performance? It’d be a lot more client focused. 30.A.2 Packet Pg. 889 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc System Coordination: z Enhance our understanding of Housing First program graduation rates. Utilize existing data to generate a better understanding of Housing First graduate rehousing to determine system capacity needs. z Explore primary public systems capacity and integration of Housing First program graduates to understand recidivism patterns back into homelessness. z Explore strategies to intentionally manage the inflow from mental health, addiction, health, and correctional facilities into homelessness and Housing First programs. z Explore opportunities to enhance and adjust current program KPIs to align with on-the-ground experiences at the front line level. These indicators, as well our interpretation and reporting of data, will need to follow an iterative process that adjusts as needed based on real time inputs from front line workers. Agile HSSC Planning Priority Areas of Focus: 30.A.2 Packet Pg. 890 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 5 ECOSYSTEM INTEGRATION ONE OF THE GREATEST CHALLENGES FACED IN OUR WORK ON HOMELESSNESS STEMS FROM THE FACT THAT HOMELESSNESS CANNOT BE SOLVED BY THE HOMELESS-SERVING SYSTEM OF CARE ALONE; IN FACT, THE HSSC ITSELF IS A SECONDARY, DEFAULT SYSTEM THAT EMERGED TO RESPOND TO THE GAPS AND FRACTURES THAT PEOPLE ARE FALLING THROUGH WITHIN THE PRIMARY PUBLIC SYSTEMS OF CARE.STRATEGIC DIRECTIVE30.A.2 Packet Pg. 891 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc ECOSYSTEM INTEGRATION HomelessnessPrevention While we continue to focus on ending long-term homelessness amongst those experiencing chronic and episodic homelessness, we must also enhance the system of care to efficiently house those at imminent risk of or who experience short-term homelessness as well. To meet our goal of achieving Functional Zero in Calgary, we need to stop people from becoming homeless in the first place. As an example, the higher incidence of homelessness among those who exit Children’s Services provides impetus to examine how that system prepares and supports young people for transitions to adulthood. In the case of Income Supports, inadequate shelter allowance exacerbates homelessness risk for those receiving social benefits yet who are unable to pay rent. This would suggest that this system could shift policy and procedures in this area to reduce homelessness long-term. The higher incidence of people experiencing mental illness in shelters also suggests a gap in the Health system that enables this issue to emerge in the first place. Similarly, the higher incidence of homelessness for people involved with the Justice system points to the need to explore what might be done around Justice investment in appropriate housing as part of the release planning process. It is very difficult to bring these systems together at the local level and engage in cross-system planning and investment coordination. This is partially to do with the accountability of systems beyond Calgary itself to the province or nationally, as well as their understanding of where accountability for homelessness lies in relation to ministerial or departmental mandates. Health might argue that homelessness is not a health issue and thus outside their responsibility realms; same could be said by Justice or Children’s Services. However, all of these systems require significant policy shifts. While difficult, this work on cross-system leadership and ecosystem planning will continue to be a priority for Calgary to achieve its objectives on ending homelessness. This will require incremental changes to primary public systems as agile system planning requires new skills, will and knowledge. OVER THE PAST DECADE, OUR EMPHASIS ON REDUCING CHRONIC AND EPISODIC HOMELESSNESS HAS FOCUSED THE HSSC’S INTERVENTIONS ON TERTIARY AND SECONDARY PREVENTION. HOWEVER, WE ALSO RECOGNIZE THAT WITHOUT ALL TYPES OF PREVENTION, SUCCESS IS VERY LIMITED. IN FACT, PREVENTING HOMELESSNESS WILL REQUIRE AN INTENTIONAL PREVENTION EFFORT TO IDENTIFY THOSE AT THE GREATEST RISK AND BEST MATCH THEM WITH APPROPRIATE RESOURCES BEFORE HOMELESSNESS OCCURS. THIS HAS IMPLICATIONS FOR GOVERNMENT AND NON-PROFIT AGENCIES WHO ARE NOT WITHIN THE HSSC TO COLLECTIVELY RECOGNIZE THAT IN ORDER TO BE PART OF THE SOLUTION, THEY WILL HAVE TO RETHINK SIGNIFICANT ASPECTS OF THEIR APPROACH TO SERVICE DELIVERY, POLICY DEVELOPMENT, AND IMPLEMENTATION. ”“We’ve increased our level of collaboration; we share a lot of information and build a lot of trust. We can expand this to the administrative and public systems too. 30.A.2 Packet Pg. 892 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc CALGARY’S HOMELES S S ERVIN G S YSTEM OF CAREYouth Families Singles Ethnicit y « L GBTQ2S+ « Human Rights « Domestic Violence « Gender Lens « Addiction « Poverty « Indigeneity « Mental Health « Aging « A c c e s s i b i l i t y « And More « HealthJusticeHousing Chi ld ren ’sServ icesIncomeSupports Calgary's Homeless- Serving System of Care is not a primary system. Public Systems The primary systems of care in our city. Though they are distinct, they integrate with each other in service to individuals. Populations The primary segmentation of individuals within the eco-system. Pressure points within the system These pressure points are common throughout the system and are not tied to primary systems. homeless-serving sector services those who fall through the primary systems. Calgary’sEcosystem: Much more needs to be done to develop effective strategies on the primary prevention side to stem the flow of new cases of homelessness before they occur. This includes the development of more affordable housing, and changing policies to ensure vulnerable groups – such as youth leaving care – are not discharged into homelessness. In addition, we need to find ways to increase incomes for vulnerable populations, including enhancing income supports, access to living wage employment, and other poverty reduction measures that are specifically aligned towards ending homelessness. However, it is important to remember that these issues and their solutions are not within the direct powers or accountability of the HSSC. In fact, growing the HSSC will never solve these systemic issues within the broader ecosystem and primary public systems. We need leadership within these systems to accept accountability and take action on addressing the gaps and drivers contributing to homelessness within their own ministries, programs and services. 30.A.2 Packet Pg. 893 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Homelessness Prevention: z Leverage Community Systems Integration (CSI) Table to drive coordination, and where appropriate, integration efforts across the HSSC with our public system partners such as Health, Children’s Services, and Justice to address the gaps and drivers within their own systems that are contributing to homelessness. z Leverage the Collaborative to Health and Home (CHH) to continue to advance access to intensive case management and health supports including mental health and addicitons services as homeless Calgarians transition into supportive housing. z Enhance the integration of the HSSC with poverty reduction and affordable housing efforts being led by Enough for All and CHAC in order to maintain momentum beyond 2018. Ecosystem Integration Priority Areas of Focus: 30.A.2 Packet Pg. 894 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 6 STRATEGIC INVESTMENT & EMPOWERING CALGARIANS WITHOUT THE SUPPORT OF ALL ORDERS OF GOVERNMENT, THE SUCCESSES WE HAVE ACHIEVED TO DATE WOULD NOT HAVE BEEN POSSIBLE, AND MOVING FORWARD, SUPPORT FROM ALL ORDERS OF GOVERNMENT WILL CONTINUE TO BE ESSENTIAL. CRITICAL MASS IS REQUIRED TO AFFECT SUSTAINABLE CHANGE, BUT CRITICAL MASS CAN ONLY BE ACHIEVED IF ALL CALGARIANS PARTICIPATE IN OUR COLLECTIVE EFFORTS TO END HOMELESSNESS IN OUR CITY, AND ACTIVELY ENGAGE IN THE BETTERMENT OF OUR COMMUNITY.STRATEGIC DIRECTIVE30.A.2 Packet Pg. 895 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc FunderEngagement The Government of Alberta supported (rather than dictated) directions to Calgary, and this created space for the emergence of local capacity to develop systems planning approaches appropriate to solve local complex social issues. This enabling approach was reinforced at the federal level by the Homelessness Partnering Strategy (now called Reaching Home) and the National Housing Strategy – which put the onus of community planning at the local level, rather than in government (provincial or federal). Notwithstanding the above, the successes we have achieved to date would not have been possible without investment from all orders of government (Federal, Provincial, Municipal) and moving forward, support from all orders of government will continue to be essential. The Federal Government’s National Housing Strategy has marked a momentous shift in the affordable housing sector, though the details of the rollout are yet to be determined. The Government of Alberta’s Affordable Housing Strategy (2017), with a commitment of $1.2 billion over five years to improve the system’s 70,000 housing units and construct an additional 4,100 units by 2021 is a promising investment within the affordable housing sphere. We will also need The City of Calgary to continue to support policies that remove barriers and increase affordable housing options and provide assertive leadership with federal, provincial and industry partners on tackling the affordable housing gap. As noted, concerted coordination and integration efforts across the HSSC with our partners in Health, Justice, Income Supports, poverty reduction, mental health and addiciton, affordable housing, and others will be required to maintain momentum beyond 2018. The levels of resources needed will require constant monitoring and adjustment to respond to shifting drivers of demand. We will need to develop common ways of measuring leading and lagging indicators provincially and nationally to ensure a consistent approach emerges. Though parts of the HSSC have been aligned through joint provincial, federal, and philanthropic funding to a high degree, resource infrastructure can and should be strategically examined from an ecosystem perspective. Failure to do so will continue to hamper efforts as we have no way of knowing whether diverse funders (governments, foundations, charities, etc.) are working at cross-purposes, duplicating efforts, or even whether we are serving different groups and to what effect. Moving forward, we need to ensure diverse funders are aligned across the HSSC and that KPIs and outcomes are co-created and shared. GOVERNMENTS’ TRUST AND ENABLING APPROACH TO LOCAL LEADERSHIP THROUGH THE COMMUNITY BASED ORGANIZATION AND COMMUNITY ENTITY MODELS WAS A CRITICAL FACTOR IN CALGARY’S SUCCESS OVER THE PAST DECADE. THEIR SUPPORT FOR LOCAL AUTONOMY IN BACKBONE ENTITY-DRIVEN SYSTEM PLANNING ALONG WITH THE PROVISION OF RESOURCES AND ENABLING POLICY WERE CRITICAL. ”“What’s working is how well we work together collaboratively as agencies and as a sector; we have built off of that and started collaborating to determine how we can provide the best sector-wide support. 30.A.2 Packet Pg. 896 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc HOME FOR EVERYONE However, there is still a considerable lack of public knowledge on homelessness as well as a great amount of shame and stigma associated with the people who experience it, and innovative approaches to connecting, informing, and engaging with the public need to be developed through a comprehensive and collective communication vehicle. Unified messaging through a single brand will contribute to a stronger HSSC voice and minimize the confusion that comes from trying to navigate multiple messages from multiple sources. Critical mass can only be achieved if all Calgarians participate in our collective efforts to achieve Functional Zero within our city, and actively engage in the betterment of our community. This requires that all Calgarians have a deeper understanding of homelessness and what causes it, and challenge the myths and stigma surrounding those experiencing it. ENDING HOMELESSNESS REQUIRES THE ENGAGEMENT OF ALL CALGARIANS, EACH CONTRIBUTING IN A MANNER THAT FITS THEIR CAPACITY. BY LENDING PUBLIC SUPPORT AND ENCOURAGING COMMUNITY ACTION ON HOMELESSNESS, MANY HAVE CONTRIBUTED TO THE SUCCESSES WE’VE HAD OVER THE PAST DECADE THROUGH EMBRACING PERMANENT HOUSING WITH SUPPORTS IN LOCAL NEIGHBOURHOODS; PROVIDING VOLUNTEER HOURS IN AFFORDABLE HOUSING BUILDINGS; AND BY FUNDRAISING TO PAY DOWN BUILDING MORTGAGES. ”“We almost have a unified voice – a better ability to advocate. Because of that, we can work really well together, streamline services, and address the problem more effectively in the future. 30.A.2 Packet Pg. 897 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Funder Engagement: z Identify opportunities for better integration of governance, funding, and policy across systems, services, and sectors to support more seamless access to, and transition among services. I Heart Home: z Develop a collective communications mechanism for the HSSC to work in concert with existing initiatives such as CHAC’s Common Voice for affordable housing. z Create more public awareness of the scope and causes of homelessness in Calgary, and the performance of programs that are delivering desired outcomes towards the collective goal. z Address the stigma and discrimination associated with homelessness in Calgary through collective HSSC communication. Strategic Investment & Empowering Calgarians Priority Areas of Focus: 30.A.2 Packet Pg. 898 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Conclusion: Together,We can get toZeroAbsolute Functional CALGARY’S HOMELESS-SERVING SYSTEM OF CARE IS COMPRISED OF A NETWORK OF AGENCIES AND PUBLIC SYSTEM PARTNERS WORKING TOGETHER TO ENSURE THAT THOSE AT IMMINENT RISK OF OR EXPERIENCING HOMELESSNESS HAVE TIMELY ACCESS TO THE RIGHT HOUSING WITH THE RIGHT SUPPORTS AT THE RIGHT TIME. THE STRATEGIC DIRECTIVES AND PRIORITY AREAS OUTLINED IN THIS GUIDING DOCUMENT ARE BASED ON THE LESSONS AND WISDOM GLEANED FROM OVER A DECADE OF COLLECTIVE IMPACT, COLLABORATION AND COORDINATION. Complex social issues like homelessness are cross-cutting, whether we consider them through the lens of a government jurisdiction, department, or service delivery approach. Across and within the ecosystem, (including the HSSC), system of care service providers and programs continue to mainly operate in a fragmented manner. The strategic directives and priority areas outlined in this guiding document provide a strategic framework to drive alignment across system of care participants and enable co-ordination at the strategic and service delivery levels to achieve Functional Zero within our city. As the system planner for Calgary’s HSSC, Calgary Homeless Foundation is honoured to continue to collaborate with the HSSC to deliver services, housing and programs, and coordinate resources in alignment with the strategic directives outlined in this document. No single agency, system or service can end homelessness alone. It’s no longer sustainable to care solely about one’s own organizational mandate and associated initiatives. To achieve transformational change we must drive for shared accountability and identify ways to co-ordinate at the ecosystem and strategic level as well as the service delivery level. 30.A.2 Packet Pg. 899 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc ”“ z Each time a person or family at risk of or experiencing homelessnes is supported to access and maintain permanent housing z When there are fewer paths in and a timely path out, for everyone z When our system response is such that: when a person falls into homelessness, the system finds them, treats them with dignity and respect, gets them into permanent housing with supports if/as needed, and does so in days and weeks – not months and years - Diana Krecsy, CEO, CHF ”“Teamwork is the ability to work together toward a common vision. The ability to direct individual accomplishments toward organizational objectives. It is the fuel that allows common people to attain uncommon results. - Andrew Carnegie We Will Have Ended Homelessness When: 30.A.2 Packet Pg. 900 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc HOME FOR EVERYONE WWW.IHEARTHOMEYYC.COM TogethertoZeroAbsolute Functional 30.A.2 Packet Pg. 901 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Mental Health and Addiction Ad Hoc Committee Meeting March 19, 2019 – 8:30 am Item 8.4 – Veteran Data for Collier County Sean, Attached is Veteran Data for Collier County provided by the VA. I sent a second request because I am missing the number of Veterans that served overseas in pre post 9-11 (Gulf Wars - Pre 9-11). Should have it very soon. Dale Mullin President dale@woundedwarriorsofcolliercounty.com 239.596.3019 (o) 203.449.7742 (c) 411 Saddlebrook Lane Naples, FL 34110 30.A.2 Packet Pg. 902 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc January 31, 2019 In Reply Refer To: Mr. Dale Mullin 411 Saddlebrook Lane Naples, FL 34110 dale@woundedwarriorsofcolliercounty.com 516/001PV FOIA 19-03120-F Dear Mr. Mullin: Thank you for your inquiry to the Bay Pines VA Healthcare System (BPVAHCS). This letter is the initial agency decision on your January 5, 2019 request under the Freedom of Information Act (FOIA), 5 U.S.C. § 552, for the following: 1. Total number of Veterans living in Collier County last census count. 2. Breakdown of the total number of Veterans served in overseas wars living in Collier County: WWII, Korea, Vietnam, Post 9-11. 3. Breakdown by gender for item #2. 4. Number of Veterans diagnosed with PTSD or TBI living Collier County (2015-2018). 5. Number of homeless Veterans reported in Collier County by year (2015-2018). 6. Number of Veterans receiving housing payments from VA/HUD in Collier County (2015- 2018). 7. Number of Veterans receiving treatment for PTSD and TBI by VA living in Collier County (2015-2018). 8. Number of Veterans arrested in Collier County (2015-2018). 9. Veteran suicides reported in Collier County (2015-2018). 10. Number of Veterans treated for substance abuse living Collier County (2015-2018). Your request was received in my office on January 7, 2019. Social Work Service, Mental Health and Behavior Sciences Service (MH&BSS), Health Administration Service and the Associate Group Practice Manager conducted a search for documents responsive to your FOIA request that were gathered or created by the BPVAHCS on or before January 5, 2019. At the conclusion of the search, the following information was determined to be responsive to your request. In response to line item 1, the Associate Group Practice Manager provided the following total number of Veterans living in Collier County last census count: County, St 9/30/2015 9/30/2016 9/30/2017 9/30/2018 9/30/2019 Collier,FL 30,407 29,324 28,242 27,164 26,094 DEPARTMENT OF VETERANS AFFAIRS Bay Pines VA Healthcare System Post Office Box 5005 Bay Pines, Florida 33744 30.A.2 Packet Pg. 903 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Page 2. Mr. Dale Mullin Data Source: National Center for Veterans Analysis and Statistics (https://www.va.gov/vetdata/veteran_population.asp) In response to line item 2, Health Adminitstration Service provided the breakdown of the total number of Veterans served in overseas wars living in Collier County: WWII, Korea, Vietnam, Post 9-11. (2V08) (516GF) Naples, FL Totals Desert Storm (Veteran) Korean 952 Operation Desert Shield Persian Gulf War 1,272 Post-Korean 575 Post-Vietnam 625 Pre-Korean 35 Vietnam Era 3,524 World War I World War II 453 In response to line item 3, Health Administration Service provided the following breakdown by gender for line item 2: (2V08) (516GF) Naples, FL Totals Female 336 Male 7,140 In response to line item 4, the Associate Group Practice Manager provided the following number of Veterans diagnosed with PTSD or TBI living Collier County (2015-2018). Note: This is the number of Veterans treated in VHA with Collier as their home county with diagnosis codes for PTSD and TBI. It is unknown how many Veterans have a diagnosis, but are not receiving treatment. In response to line item 5, Social Work Service provided the number of homeless Veterans reported in Collier County by year (2015-2018): FY COC homeless sheltered unsheltered 2015 FL 606 5 5 0 2016 FL 606 5 4 1 2017 FL 606 9 4 5 2018 FL 606 11 3 8 30.A.2 Packet Pg. 904 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Page 3. Mr. Dale Mullin In response to line item 6, Social Work Service provided a “no records” response concerning the number of Veterans receiving housing payments from VA/HUD in Collier County (2015-2018). Social Work Service explained that while there are a few Housing and Urban Development-Veterans Administration Supportive Housing (HUD-VASH) Veterans residing in Collier through the HUD portability system, there are no HUD-VASH vouchers allocated to Collier County. In response to line item 7, the Associate Group Practice Manager provided the number of Veterans receiving treatment for PTSD and TBI by VA living in Collier County (2015-2018). In response to line item 8, the Associate Group Practice Manager and Social Work Service provided a “no records” response for the number of Veterans arrested in Collier County (2015-2018). Social Work Service explained that this information it may be obtained through the court system. In response to line item 9, Mental Health and Behavioral Sciences Service provided a “no records” response to the number of Veteran suicides reported in Collier County (2015- 2018). Mental Health and Behavioral Sciences Service explained that there are no known suicides among Veterans who resided in Collier County in the Suicide Prevention Application Network (SPAN) tracking system during that timeframe (2015-2018). In response to line item 10, the Associate Group Practice Manager provided the following number of Veterans treated in VHA with Collier County as their home county and a diagnosis of Substance Use Disorder. Please be advised that you may appeal the “no records” response to: Office of the General Counsel (024) Department of Veterans Affairs 810 Vermont Avenue, N.W. Washington, D.C. 20420 Email: ogcfoiaappeals@va.gov 30.A.2 Packet Pg. 905 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Page 4. Mr. Dale Mullin If you should choose to file an appeal, your appeal must be postmarked or electronically transmitted no later than ninety (90) calendar days from the date of this letter. Please include a copy of this letter with your written appeal and clearly state why you disagree with the determinations set forth in this response. You may also seek assistance and/or dispute resolution services for any other aspect of your FOIA request from VHA’s FOIA Public Liaison and/or Office of Government Information Services (OGIS) as provided below: VHA FOIA Public Liaison: Email Address: vhafoia2@va.gov Phone Number: (877) 461-5038 Office of Government Information Services (OGIS) Email: ogis@nara.gov Fax: (202) 741-5769 Mailing address: Office of Government Information Services National Archives and Records Administration 8601 Adelphi Road College Park, MD 20740-6001 Thank you for your interest in VA. If you have any further questions, please feel free to contact me at (727) 398-6661, extension 14626. Sincerely, 30.A.2 Packet Pg. 906 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Mental Health and Addiction Ad Hoc Committee Meeting March 19, 2019 Item 8.5 – Review of Committee Vacancies Filled Positions Membership Credential Committee Member Organization 1 Veterans Service Organization Dale Mullin Wounded Warriors of Collier 2 Collier County Sheriff’s Office Lt. Leslie Weidenhammer CCSO 3 Licensed Psychiatrist/Psychologist Dr. Emily Ptaszek Healthcare Network of SWFL 4 Licensed Behavioral Health Prof. Susan Kimper NCH 5 Medical Health Professional Dr. Thomas Lansen 6 David Lawrence Center Scott Burgess DLC 7 NAMI Dr. Pam Baker NAMI 8 At-large Honorable Janeice Martin 20th Judicial Circuit 9 Collier County Grantor Agency Robert (Reed) Saunders 10 Homeless Advocacy Organization Christine Welton Hunger & Homeless Coalition 11 Peer Specialist CM Michelle McLeod City of Naples 12 Recovery Community Janice Rosen 13 At-large Dr. Michael D’Amico 14 At-large Russell Budd PBS Contractors 15 At-large Pat Barton 16 At-large Dr. Jerry Godshaw 17 At-large Dr. Paul Simeone Lee Health Vacant Positions Membership Credential Committee Member Organization At-large (2) Vacant 30.A.2 Packet Pg. 907 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc Mental Health and Addiction Ad Hoc Committee Meeting March 19, 2019 – 8:30 am Item 9.3 Discussion of Bed Supply Per Capita THIS IS A ONE WAY COMMUNICATION. Good evening, Committee Members. Please find two items that Pam Baker wanted to share with the Committee attached to this email. The first is an article regarding psychiatric beds per capita. This article provides (particularly pages 3-4) some clarity to the question raised by Judge Martin at Friday’s meeting. Pam emphasized that the number includes state hospital beds. The second attachment shows the number of licensed psychiatric hospital beds in Collier County. Per Pam’s email: “Attached shows the number of licensed psychiatric hospital beds in Collier County. This does not include the DLC CSU which is not a ‘hospital’ by definition. With the Willough at 82 and NCH 23, we technically already have more than the recommended number. They just are not used for emergent / Baker Act capacity. Thank you for distributing to the Committee.” Have a good evening. Respectfully, Sean Callahan Exec. Director of Corporate Business Operations Office of the County Manager 3299 Tamiami Trail E, Building F, Suite 202, Naples Florida 34113 Phone: 239.252.8383 Cell: 239.272.6516 E-mail: Sean Callahan@colliercountyfl.gov “HOW ARE WE DOING?” Please CLICK HERE to fill out a CUSTOMER SURVEY. We appreciate your feedback! 30.A.2 Packet Pg. 908 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 30.A.2 Packet Pg. 909 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County BACKGROUND PAPER September 2016 Psychiatric Bed Supply Need Per Capita SUMMARY The United States is in the midst of a psychiatric bed shortage that worsens every year. By early 2016, the practice of closing state mental hospitals, often called “deinstitutionalization,” had eliminated more than 96% of the last-resort beds that existed in the mid-1950s; after a brief period of expansion in the 1990s, private hospitals, too, are shrinking their psychiatric inpatient capacity. The consequences are many and far-ranging, yet most states continue to decrease the number of state hospital beds they supply per capita and, because of financial disincentives, private and other inpatient-service providers are not stepping in to replace those that are lost. Despite widespread consensus that “more beds are needed,” neither the United States nor its individual states have conducted research to establish evidence-based bed supply ranges. The Treatment Advocacy Center in 2008 published the most commonly cited bed target in the United States — 40 to 60 beds per 100,000 people — but no official effort has been made to validate or revise this number. New computer modeling holds promise for developing evidence-based targets in the future. ________________ BACKGROUND Although most people with a diagnosed mental illness never require hospitalization, and many with the most serious conditions can be successfully treated in the community, inpatient psychiatric treatment remains an essential component of a complete mental healthcare continuum. “While community and hospital-at-home teams can be effective for many (but not all) patients, inpatient care is essential when an acute episode is accompanied by potentially high risks of suicide or violence,” Stephen Allison and a team of international colleagues write in the September issue of Australian & New Zealand Journal of Psychiatry. Psychiatric units in general hospitals and private psychiatric hospitals occasionally admit individuals who are severely ill, but most do not have the resources to provide intensive psychiatric care. Additionally, because individuals with the most severe and chronic mental illnesses experience high rates of unemployment, poverty and homelessness, they often do not have personal resources or health insurance to pay for their hospitalization, which discourages hospitals from admitting them. In 2013, uninsured individuals with schizophrenia or bipolar disorder were less likely than any other psychiatric patient category to receive hospital care. As La and colleagues write in their 2015 report on psychiatric bed supply and demand in North Carolina, “state psychiatric hospitals are the ultimate safety net for people with mental illness.” Yet the number of available psychiatric beds grows smaller every year. In 1955, there were an estimated 559,000 state and county psychiatric beds, or nearly 340 beds per 100,000 people. By early 2016, the state hospital bed population had dropped more than 96%, to 37,679 beds, or 11.7 beds per 100,000 people. Of these, nearly half were occupied by criminal offenders with serious mental illness; barely six beds per 100,000 people remained for individuals with acute or chronic psychiatric disease who had not committed crimes. 30.A.2 Packet Pg. 910 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 2|Page Treatment Advocacy Center • www.TreatmentAdvocacyCenter.org Psychiatric Bed Supply Need Per Capita Allison, S., Bastiampillai, T., Fuller, D. A., Gupta, A., and Sherry, K. W. Chan. (2016). The Royal Australian and New Zealand College of Psychiatrists guidelines: Acute inpatient care for schizophrenia. Australian & New Zealand Journal of Psychiatry. La, E. M., Lich, K. H., Wells, R., Ellis, A. R., Swartz, M. S., Zhu, R., & Morrissey, J. P. (2015). Increasing access to state psychiatric hospital beds: Exploring supply-side solutions. Psychiatric Services, 67, 523–528. Retrieved from http://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.201400570 . Parks, J., & Radke, A. (Eds.). (2014). The vital role of state psychiatric hospitals. Alexandria, VA: National Association of State Mental Health Program Directors. Retrieved from http://www.nasmhpd.org/sites/default/files/The%20Vital%20 Role%20of%20State%20Psychiatric%20HospitalsTechnical%20Report_July_2014.pdf Agency for Healthcare Research and Quality. National statistics on mental health hospitalizations. US Department of Health & Human Services. Fuller, D. A., Sinclair, E., Geller, J., Quanbeck, C., Snook, J. (2016). Going, going, gone: Trends and consequences of eliminating state psychiatric beds, 2016. Arlington, VA: Treatment Advocacy Center. CONSEQUENCES When the safety net shrinks, the consequences appear to be many and far-ranging: • Emergency rooms overwhelmed by people in psychiatric crisis, resulting in critically ill psychiatric patients waiting days and even weeks to be admitted to a hospital • Mentally ill inmates who cannot be tried because they are unstable but who cannot be treated because there is no bed available for them • Ultra-short hospital stays for patients who do get admitted in order to turn beds over • Acutely ill individuals left untreated to suffer consequences that are often dire and sometimes fatal to themselves or others. Despite the impact and cost of such consequences — and the growing outcry they have provoked from a variety of constituencies — evidence-based guidelines for policymakers and public health officials to use in establishing and maintaining a safe minimum number of psychiatric beds do not exist. Informal consensus estimates and localized anecdotes serve in their place. A team of researchers in North Carolina has developed a computer-based alternative that holds promise but has not been applied to practice. American College of Emergency Physicians. (n.d.). “Psychiatric Emergencies.” Retrieved from http://newsroom.acep.org/fact_sheets?item=30093. Fuller, D. A., Sinclair, E., Geller, J., Quanbeck, C., Snook, J. (2016). Going, going, gone: Trends and consequences of eliminating state psychiatric beds, 2016. Arlington, VA: Treatment Advocacy Center. Allison, S., Bastiampillai, T., Fuller, D. A., Gupta, A., and Sherry, K. W. Chan. (2016). The Royal Australian and New Zealand College of Psychiatrists guidelines: Acute inpatient care for schizophrenia. Australian & New Zealand Journal of Psychiatry. 30.A.2 Packet Pg. 911 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 3|Page Treatment Advocacy Center • www.TreatmentAdvocacyCenter.org Psychiatric Bed Supply Need Per Capita CONSENSUS BED SUPPLY RANGE In 2008, the Treatment Advocacy Center published a study that included a safe minimum number of public beds for adequate psychiatric services per 100,000 populations. Estimates were solicited “from 15 experts on psychiatric care in the US, [including] individuals who have run private and state psychiatric hospitals, county mental health programs, and experts on serious psychiatric disorders.” Participating experts were asked to estimate beds for children and forensic (criminal justice-involved) patients, as well as civil, adult patients. An estimated range of 40-60 public psychiatric beds per 100,000 people emerged, with a consensus around 50 beds per 100,000 population. Across the 34-member Organization for Economic Cooperation and Development (OECD), to which the United States belongs, the median number of psychiatric beds per 100,000 people in 2014 was 68 beds. This suggests that international policy and practice are operating slightly above the upper end of the consensus range. Torrey, E. F., Entsminger, K., Geller, J., Stanley, J., Jaffe, D. J. (2008). The shortage of public hospital beds for mentally ill persons. Arlington, VA: Treatment Advocacy Center. Organization for Economic Cooperation and Development. (2013). Health at a glance 2013: Hospital beds by function of health care, 2011 (or nearest year). Paris: OECD Publishing. Retrieved from http://www.keepeek.com/Digital-AssetManagement/oecd/social-issues-migration-health/health-at-a-glance- 2013/hospital-beds-by-function-of-health-care- 2011-or-nearest-year_health_glance-2013-graph72-en#page2 EVIDENCE-BASED BED SUPPLY RANGES Of the many social and personal conditions reported to correlate with psychiatric bed shortages, emergency room “boarding” of psychiatric patients because no bed is available for them and jail/prison wait-listing of mentally ill inmates for the same reason serve as the most direct indicators of how well the current psychiatric bed population is meeting demand. In that context, the American College of Emergency Physicians reports that ER boarding of psychiatric patients is now virtually universal in the United States, with some patients waiting weeks for hospital admission. At the same time, a majority of the states report maintaining wait lists for forensic beds, with some inmates waiting weeks for admission to a bed. While factors such as the adequacy of community-based services that avert the arrival of mentally ill patients in the ER or inmates in the jail, bed shortages are clearly implicated. When a California county simultaneously halved the number of its psychiatric beds and closed its outpatient stabilization clinic, the number of visits to the local medical center for psychiatric consultation tripled, and ER boarding times skyrocketed. These reports provide evidence that the current mental health bed population is not sufficient but continue to leave unanswered the question of how many beds would be necessary to better align supply with demand. A team of researchers at the University of North Carolina (UNC) and Duke University in 2015 reported on a computer modeling-based approach to answering the question. La and colleagues analyzed emergency room waits and hospital admissions for a 25-county region of North Carolina that is home to a population of 3.4 million people. The region’s total psychiatric bed capacity consisted of 398 beds in a state hospital, 494 adult psychiatric beds in 14 general or private psychiatric hospitals, and 66 non-hospital crisis beds in five facilities. Combined, this totaled 958 psychiatric beds, or approximately 28 adult beds per 100,000 population. The 30.A.2 Packet Pg. 912 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 4|Page Treatment Advocacy Center • www.TreatmentAdvocacyCenter.org Psychiatric Bed Supply Need Per Capita average wait time in an emergency room for one of these beds at the time of the study (2010 to 2012) was 3.3 days. The authors used a computer simulation program to model different scenarios to ascertain how many additional psychiatric beds would be needed to achieve an average preadmission wait time of less than one day. The answer was 356 additional beds (total bed capacity of 1,314 patients) or about 39 adult beds per 100,000 population — approximately the lower end of the consensus range. This calculation included only adult patients (ages 18 – 64) and assumed a median duration of stay in the state hospital of 20 days, which was typical in the hospital under study at that time. This calculation did not include psychiatric beds for children or for forensic patients, who usually stay for extended period. La and colleagues noted other measures can be taken to decrease the need for psychiatric beds but their impact was outside the scope of the study. Such measures include assertive community treatment and the use of assisted outpatient treatment (AOT) to ensure medication adherence. In the state of South Australia (SA), public officials have essentially created a real-time test of the computer modeling project, adding psychiatric inpatient beds with the express purpose of reducing emergency room wait times for psychiatric patients. In October 2014, 284 psychiatric patients in the state were reported held in SA emergency rooms for 24 hours or more before admission to a mental health bed. By December 2015, that number was reduced nearly 75%, to 76 patients, and the average wait time for psychiatric hospitalism was cut in half. To reach that level, the state added 30 new acute care beds (typically used for patients with psychotic symptoms) and six new forensic beds. An additional four forensic beds were scheduled to reduce the time mentally ill offenders waited behind bars for a bed. American College of Emergency Physicians. (n.d.). Psychiatric emergencies [Fact sheet]. Retrieved from http://newsroom.acep.org/fact_sheets?item=30093 American College of Emergency Physicians. (2014.) Care of the psychiatric patient in the emergency department. Nesper, A. C., Morris, B. A., Scher, L. M., & Holmes, J. F. (2015). Effect of decreasing county mental health services on the emergency department. Annals of Emergency Medicine. Torrey, E.F. (2008). The Insanity Offense. New York: W.W. Norton. Stettin, B. (2014). An advocate’s observations on research concerning assisted outpatient treatment. Current Psychiatry Reports. Health Management Associates. (2015). State and community considerations for demonstrating the cost effectiveness of AOT services. Retrieved from http://tacreports.org/storage/documents/aot-cost-study.pdf Siebert, B. (2016, February 12). Mental health emergency room waiting times halved. InDaily. Retrieved from http://indaily.com.au/news/2016/02/12/mental-health-emergency-room-waiting-times-halved/ 30.A.2 Packet Pg. 913 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc 5|Page Treatment Advocacy Center • www.TreatmentAdvocacyCenter.org Psychiatric Bed Supply Need Per Capita CONCLUSION Psychiatric hospitals represent only one point on a care continuum, but they are a critical one for individuals in psychiatric crisis or otherwise in need of intensive services. As the Treatment Advocacy Center reported in Going, Going, Gone, its 2016 state survey of trends in hospital bed population, “With lawsuits and court orders proliferating over illegal boarding of psychiatric patients in hospital ERs and bed waits in jails, there is little doubt the United States needs more psychiatric beds to meet inpatient demand.” The report’s recommendation remains relevant: “In recognition of the national scope and consequences of the bed shortage and the need for baseline data nationwide and tools for setting targets,” the federal government should assess hospital bed need by type, facility and location. . . .” Fuller, D. A., Sinclair, E., Geller, J., Quanbeck, C., Snook, J. (2016). Going, going, gone: Trends and consequences of eliminating state psychiatric beds, 2016. Arlington, VA: Treatment Advocacy Center. 30.A.2 Packet Pg. 914 Attachment: [Linked] Agenda and Back-up Document Packet - March 19, 2019 (8622 : Collier County Mental Health and Addiction Ad Hoc