III. Current Services and Service Gaps Analysis — 2006 Update
Services for Alaskans experiencing developmental disabilities, alcoholism or other drug addictions, mental or emotional illnesses, and Alzheimer’s disease or other dementias were originally shaped and frequently compartmentalized by federal funding availability and federal program requirements. Advocates and program managers have long recognized that service integration is a first step toward higher quality services, increased access to services, and greater cost savings. In addition, many people experience more than one beneficiary disability during the course of their lifetimes. Simplifying and coordinating services for people with multiple cognitive or developmental disabilities is both cost effective and provides better care. Initiatives, discussed in a later section, address gaps in service delivery systems.
Components of Care
Figure 15 — Components of Care for Trust Beneficiary Groups
The Trust and the Department of Health and Social Services support the components of care illustrated in Figure 15, ranging from prevention at the bottom to acute care at the top for people requiring intensive care. Public education and prevention services reach large audiences. Services in the middle of the triangle are home and community based and used by those people requiring a less intensive level of care. Although economies of scale restrict some services to urban areas, the Plan’s vision is that appropriate services would be available when needed across the state. The components of care listed are only those that serve three or more beneficiary groups. These same components are also shown in Table 2 - Matrix of Current CIMHP Services.
Table 2 shows the geographic availability of services by three of more Trust beneficiary groups:
Service Gaps Analysis
The matrix in Table 2 represents a first effort to analyze those similar services provided by separate service delivery systems to different Trust beneficiary groups. Planning staff (DHSS, The Trust, AMHB, ABADA, GCDSE, ACoA, and the Department of Corrections) developed this matrix by comparing service definitions used by different programs and coming to agreement about common definitional elements and suitable aggregate definitions. Next, based on the common definitions, the group assessed service availability using the Alaska Mental Health Board’s Level of Community template. This assessment was based on data and documents produced by the agencies represented by the planning staff.
Development of the matrix assists in considering collaborative approaches and in determining priorities for service needs. Several observations can be made from the matrix:
Many commonalities exist among services to beneficiaries, especially in such specialized services as medical, dental and pharmacy services.
The more specialized the service, the more likely it is to have substantial gaps in delivery. For example, even in Alaska ’s metropolitan area ( Anchorage ), gaps exist in direct and rehabilitation care, the foundation of personal support and recovery: even when a service is available, “gaps” may reflect a lack of capacity to serve all who need that service.
Access to care and participation in community life may require specialized transportation, a service that is needed across all levels of community.
The matrix also shows that despite efforts to develop services in regional centers, this strategy has not yet produced a full range of adequate care in those areas.
Below the regional center level, many gaps exist, both for individualized services and for facility based care.
Some service delivery programs, notably those for people with Alzheimer’s disease or similar dementia and for people with developmental disabilities, try to meet each person’s particular needs in their own homes. Ideally, this would mean that all services could be made available at each level of community. However, the reality is that resources frequently limit such delivery. Often, providers may not be available in a community, but more commonly, resources do not meet current need. For example, about 1,006 people with developmental disabilities were waiting for services at the end of fiscal year 2006. 40
The Trust and the Department have targeted development of infrastructure and resources for many of these services.