Background

In the United States, there are barriers to accessing mental health services, especially for Medicaid recipients, who face additional challenges in receiving care compared to their peers who use private insurance. Medicaid recipients often have decreased provider acceptance rates and increased wait times for care. Reimbursement rates can influence the availability and quality of mental health services for these recipients, highlighting the importance of evaluating compensation frameworks and their impact on the access and delivery of mental health services.

The Allegheny County Department of Human Services (DHS) partners with Community Care Behavioral Health (CCBH) to provide behavioral health services for Medicaid recipients. The resources (i.e. report and summary) present a decade (2010-2019) of information, encompassing claims data (i.e. billing and payment records) and rate variations. Analyzing data prior to COVID-19 ensures findings and inferences from the data reflect pre-pandemic conditions only.

What You Need to Know

The report evaluated over 1,100 behavioral health providers and over 90 service codes. The evaluation of reimbursement rates and service availability has identified some relationships between provider responsiveness and payment systems.

• A 20% increase in Medicaid reimbursement rates resulted in a 3.2% increase in services offered, demonstrating a small yet positive relationship. The increase in reimbursement rates offered a temporary increase in service provisions, but this effect was not sustainable, eventually declining or disappearing within 4-5 years. 
• Established clients made up more of scheduled visits than new patients during this time of rate and service increases.
  
• Larger providers have less challenges in adopting and adapting to rate fluctuations than smaller providers.

Why This Matters and What’s Next

In Allegheny County, Medicaid reimbursement rates are generally lower than Medicare rates. The disparity in these funding mechanisms suggests Medicaid enrollees are less attractive to providers than Medicare recipients. The analysis also suggests rate increases did not offer a sustainable solution for increased access to mental health services. Addressing system-level constraints (e.g. workforce shortages, limited facility capacity) may facilitate development of sustainable and equitable approaches to receiving care. Additionally, continued monitoring and evaluation of the needs of small providers, the disparity between Medicare and Medicaid rates, and the demand for a long-term sustainable strategy for service provisions may be particularly beneficial, as these efforts may be crucial in establishing effective and equitable health care solutions for Allegheny County and the nation.

Overview: 

In 2021 and 2022, states and localities reached historic settlements with manufacturers and distributors of opioids, as well as pharmacy chains and a consulting firm, for their roles in the opioid epidemic. The settlement funds were designed to promote the long-term goals of (1) reducing fatal overdoses and (2) reducing the harms from opioid use disorder. As a result of these settlements, Allegheny County will receive annual payments in varying amounts through at least 2038.

In 2022, Allegheny County received $8.4M and in 2023 the county received $6.05M in settlement funds. In December 2024, however, Allegheny County received $26.4M in 2024 from Opioid Settlements — a payment that is substantially larger than payments received in 2022 and 2023 and those expected in future years. In preparation for receiving the 2024 payment(s), Allegheny County solicited feedback from community members, providers, and other stakeholders through a series of listening sessions. These sessions aimed to engage and inform the public about the impact of opioids on the community and to collaboratively brainstorm solutions for opioid misuse.

What You’ll Gain from the Resources: 

The linked resources provide background on the national opioid settlements and detail how Allegheny County has allocated settlement payments to enhance the substance use services system.

The listening sessions report (2025) describes Allegheny County’s community engagement efforts and summarizes participants’ top priorities for settlement fund investments. Some major takeaways from the sessions include the need to reduce stigma, expand harm reduction services, improve access to treatment, and address housing and economic barriers that make recovery from opioid addiction hard. To learn more about community-driven priorities and planned investments, consider reading the full report.

The dashboard offers additional insights into funding distribution and shows how investments support initiatives.

Trouble viewing the dashboard below? You can view it directly here.

 

 

 

The Allegheny County Department of Human Services (DHS) engages clients and others who interact with DHS programs in a variety of ways: regular roundtables/cabinets (e.g., Children’s Cabinet); town halls and community forums; social media (e.g., Facebook and LinkedIn); and the Director’s Action Line (DAL). In 2018, DHS expanded its public engagement strategy to include SMS text messaging (texting), a tool that is convenient for recipients and allows DHS to scale up communication with clients and other Allegheny County residents.

How does DHS use text outreach? 

DHS uses text outreach in a variety of ways, including collecting feedback after a service touchpoint, increasing program engagement, recruiting for paid research opportunities, and providing timely alerts. Text messaging has allowed DHS to connect clients to resources at scale, and to solicit feedback from clients who would likely never otherwise have the time or opportunity to share their feedback.

What data is available?

The data brief provides more information about the communication strategy and descriptive analytics from 2018 to 2022. The interactive dashboard, which is updated daily, allows users to drill down to individual text campaigns to understand the purpose, the number of messages sent, and the demographics of people who were contacted.

Terms and Conditions

This service is used by the Allegheny County Department of Human Services to send you notifications about publicly funded services. You can cancel this service at any time. Just text “STOP” to 987987. After you send the message “STOP” to us, we will send you a reply message to confirm that you have been unsubscribed. After this, you will no longer receive messages from us. If you want to join again, just text “START” to 987987, and we will start sending messages to you again. If at any time you forget what keywords are supported, just text “HELP” to 987987 After you send the message “HELP” to us, we will respond with information about the program. Message frequency varies. Carriers are not liable for delayed or undelivered messages. As always, Message and Data Rates May Apply for any messages sent to you from us and to us from you. If you have any questions about your text plan or data plan, it is best to contact your wireless provider. For all questions about the services provided by this short code, you can contact us at DHS-Research@alleghenycounty.us

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Since 2016, Allegheny County Jail has been expanding access to MOUD to incarcerated individuals. This dashboard serves as a tool to display the current population of incarcerated individuals who are receiving MOUD in ACJ, as well as associated outcomes before and after their release.

Medication for opioid use disorder (MOUD), which includes the medications buprenorphine, methadone, and naltrexone, is a critical component to helping individuals who are incarcerated reduce risks of overdose and relapse upon release. Individuals receiving MOUD are also more likely to continue treatment post-incarceration, which leads to better long-term recovery outcomes, like lower recidivism rates. By addressing the opioid use disorder within the jail system, communities can see a positive impact on both individual lives and broader societal health.

Allegheny County Department of Human Services (DHS) developed these publicly available, interactive dashboards in collaboration with resolve Crisis Services, the County’s provider for the 24-hour, 365-day mental health crisis service provided free to all Allegheny County residents.

These dashboards provide information about:

Crisis Calls: Overview of call volume to resolve Crisis Services through 988 Suicide & Crisis Lifeline and resolve’s 24-hour hotline 1-888-7-YOU-CAN (796-8226), consumer wait time to reach call clinician, abandoned call rate, and demographics of person-in-crisis who received call services. Aggregate call information is from April 2021 to present and is updated monthly. Demographic information is available from March 2023 to present and is updated monthly.

Mobile Team Dispatches: Overview of mobile team dispatch volume, consumer wait time, reasons for mobile team dispatch, dispatch rate by neighborhood, and demographics of people-in-crisis who received mobile interventions. Information is available from September 2023 to present. Data updated monthly.

Police Involvement: Percentages of calls and mobile team dispatches with police involvements. Information is available from September 2023 to present. Data updated monthly.

Making good, informed decisions about how to allocate limited resources is an ever-evolving process. The Allegheny County Department of Human Services (DHS) strives to make the most equitable decisions when allocating scarce resources for individuals and families in need. Housing is a critical resource for which demand far exceeds supply; thus, DHS is dedicated to making sure that those most at need have priority for the housing services that are available. Since 2017, DHS has developed predictive risk models that utilize administrative data to assign a risk score that is used to determine the appropriate course of action. Two of these models were developed to support prioritization of housing resources.

Allegheny Housing Assessment (AHA)

In 2020, DHS launched the Allegheny Housing Assessment (AHA), a decision support tool designed to help prioritize admissions to supportive housing services for individuals or families experiencing homelessness. The AHA forms the infrastructure for DHS’s coordinated entry system for those in a housing crisis.

The tool uses administrative data from Allegheny County’s data warehouse to predict the likelihood of three types of events occurring in a person’s life if they remain unhoused over the next 12 months: 1) a mental health inpatient stay, 2) a jail booking and 3) frequent use (4 or more visits) of hospital emergency rooms.  These events serve as indicators of harm if a person remains unhoused. The AHA assigns a risk score that is used as part of the housing prioritization process; it is far more objective and unbiased than earlier assessment tools and it doesn’t require the time or trauma associated with asking sensitive questions at the time of housing crisis.

Select from the following documents to learn more about the AHA tool:

• • • Using Predictive Risk Modeling to Prioritize Services for People Experiencing Homelessness in Allegheny County: Methodology Report for the Allegheny Housing Assessment Tool (September 2020)
    • Methodology Update (December 2020)
    • Frequently asked questions about the implementation of the Allegheny Housing Assessment tool
    • Summary of client feedback on the new housing prioritization process
    • Independent ethical/data science review of the Allegheny Housing Assessment
    • DHS’s response to the ethical review

Mental Health – Allegheny Housing Assessment (MH-AHA)

After a couple of years of experience with the AHA, DHS leadership realized that a similar tool could help prioritize admissions to residential services for individuals with a diagnosis of serious and persistent mental illness. Using the AHA as a starting point, the team developed the Mental Health – Allegheny Housing Assessment (MH-AHA) and launched it in February 2023.

Similar to the AHA, the MH-AHA utilizes administrative data from Allegheny County’s data warehouse to predict the likelihood of two potential types of adverse events that may occur in an individual’s life if they do not receive adequate support for their MH condition over the next 12 months: 1) a mental health inpatient stay and 2) frequent use [4 or more visits] of hospital emergency departments. These events serve as indicators of harm and are things we would like to prevent. The MH-AHA assigns a risk score that is used as part of the prioritization process. Individuals who are not eligible or who do not receive a risk score likely to lead to a placement in the near future will be introduced to other supportive services options instead of waiting a long time on a waiting list for a placement that might not occur.

By prioritizing those most in need of MH residential services, the MH-AHA will simplify the referral process, decrease uncertainty and reduce wait times. In addition, it will help Allegheny County document unmet MH residential needs created by the gap between limited MH residential resources and the number of high-risk eligible individuals. An external impact evaluation by researchers at Stanford will document progress toward these goals.

Select from the following documents to learn more about the MH-AHA:

• • • Methodology Report for the Mental Health-Allegheny Housing Assessment Tool (November 2023)
    • Frequently asked questions about the implementation of the Mental Health-Allegheny Housing Assessment Tool
    • Video overview of Mental Health – Allegheny Housing Assessment Tool to Behavioral Health Providers (July 2024)

Allegheny County residents face significant challenges in accessing behavioral health services, an issue highlighted by recent studies and surveys. Notably, a Countywide survey revealed that 42.7% of respondents believe improving access to mental health care, particularly for young people, should be a priority. This finding is supported by research from the University of Pittsburgh, which documented long wait times for appointments and challenges in connecting with providers. These issues stem from a critical shortage of behavioral health professionals and are compounded by time-consuming provider search processes.

In response, the Allegheny County Department of Human Services (DHS), along with Community Care Behavioral Health (CCBH), the County’s behavioral health managed care organization, are pursuing a series of investments and initiatives aimed at addressing these barriers and increasing service availability.

To improve access and reduce wait times, DHS and CCBH are focusing on:

• Creating visibility into appointment availability so clients and providers spend less time searching for services.
• Supporting the behavioral health workforce through loan repayment and cohort-based training programs to increase the number of providers.
• Investing in community-based mental health supports to offer additional options outside the traditional system.
• Expanding access to proven treatments like medication-assisted therapy for opioid addiction, cognitive behavioral therapy and group therapy.
• Augmenting clinical decision-making to ensure those who need help most get it quickly

The 2008 Act 33 Amendment to the Pennsylvania Child Protective Services law requires state and local reviews of all child fatalities and near fatalities that result from suspected child abuse. In response, the Allegheny County Department of Human Services (DHS) conducts a comprehensive and multidisciplinary review of child fatalities and near fatalities in cases where there is suspicion of child abuse or neglect. These reviews are a component of DHS’s continuous quality improvement process.

What is this report about?

This report covers child fatalities and near fatalities (critical incidents) in Allegheny County reviewed in 2022 and 2023 with a focus on drug ingestions, which have been a growing cause of these critical incidents. The increase in child ingestions and fatalities has been a nationwide trend in recent years and has worsened amidst the nation’s opioid epidemic. The County seeks to understand how these incidents happen and the circumstances surrounding them so that it can develop strategies to minimize them.

What are the takeaways?

• There were 50 critical incidents that occurred during 2022 and 2023. Forty percent (20) of these incidents were the result of unintentional drug ingestion. Unintentional ingestion comprised one-third of the 2022 incidents, rising to nearly one-half in 2023. The number of ingestion-related incidents has been rising year-over-year since 2019 and has been the primary cause of the County’s fatalities and near fatalities since 2022, surpassing blunt force or penetrating trauma and abusive head trauma.
• In 18 of the 20 ingestion cases, at least one of the substances ingested was an opioid. Eighty-six percent of the near fatal and 100% of the fatal ingestions involved opioids.
• The majority (70%) of ingestions occurred in children below the age of three. 40% of victims of ingestions were between one and two years of age compared to 27% of victims of non-ingestion fatalities and near fatalities. This age group are especially at risk for unintentional ingestion as they begin to gain mobility, which increases the likelihood of coming into contact with substances.
• Only 4 (20%) families of ingestion-related critical incidents had active child welfare involvement at the time of the incident, though three quarters (15) of families had a history of child welfare involvement prior to the ingestion incident.
• Sixty-six percent of alleged perpetrators in ingestion cases had received publicly funded substance use disorder services prior to the critical incident.  However, there was a reduction in engagement with these services within a year (43%) and within a month (36%) prior to the critical incident.
• Of the known alleged perpetrators in ingestion cases, 41% had utilized medication for opioid use disorder (MOUD) at some point before the critical incident. There was a steady decrease in MOUD use leading up to the critical incident with 31% using MOUD within the year and 13% within the month prior to the critical incident. 

How is this report being used?

Allegheny County is taking an active role in addressing the ramifications of the opioid epidemic and the rising trend of unintentional ingestions. This includes enhanced training for Child welfare staff and access to naloxone, lockboxes and fentanyl test strips for caseworkers to provide to clients. The County, through its opioid settlement funds, has expanded convenient access to MOUD and evidence-based treatment (e.g., mobile medication, telemedicine prescribing, and incentives for abstinence from stimulants and opioids) and launched a Countywide marketing campaign in April 2024 warning about the dangers of opioid ingestions and the safety of administering naloxone to children. In addition, it has invested in preventative programming like residential substance use disorder treatment that allows families to reside together during a person’s treatment and in the Hello Baby approach, a collaboration which is designed for parents with newborns to improve family outcomes and maximize child and family well-being, safety and security.

Other information

Explore updated annual data and prior reports here.

What is the Community Need Index?

The Allegheny County Department of Human Services (DHS) conducts a Community Need Index (CNI) to identify specific areas that are in greater need, and face larger socioeconomic barriers, relative to others. The newest version of the CNI index ranks neighborhoods by need level by looking at:

• The percentage of families who live below the poverty line
• The percentage of unemployed or unattached males
• The percentage of those aged 25 and up without at least a Bachelor’s degree
• The percentage of single parent households
• The percentage of households without internet access
• Rate of homicide per 100,000 residents
• Rate of fatal overdoses per 100,000 residents

The researchers used a census tract level to break up the region and assess needs. Census tracts are static, relatively small subdivisions of a county.

How can I view the findings?

An interactive map allows users to view and extract data from the 2024 CNI (which uses 2022 five-year data estimates and totals). The new report focuses on all of Allegheny County, examines changes in need over time, and places emphasis on the connection between race and community need. Earlier reports are linked below.

What are the takeaways?

• In Allegheny County, we continue to find the highest levels of need in specific sections of the City of Pittsburgh (Hill District, South Hilltop, parts of the West End, Upper East End neighborhoods, Upper Northside) as well as census tracts outside the City of Pittsburgh (Mon Valley, sections of the Allegheny County River Valley, sections of Penn Hills, sections of Wilkinsburg, Stowe-Rocks).
• There are vast discrepancies between the lowest need communities, which have an average poverty rate of 2%, and the highest need communities, where the average poverty rate is 38%.
• With few exceptions, census tract-level community need is persistent over time.
• Only about one-third of Allegheny County’s Black residents live in lower-need communities. For every other racial and ethnic group in the County, the majority of residents live in lower need communities. Black communities in Allegheny County have disproportionately high levels of need, as do a number of racially mixed communities. 
• Poverty status alone does not account for where various racial and ethnic groups tend to live by level of need; poor Black and Latino families are more likely than other poor families to live in higher need communities. Even Black families above the poverty line are many times more likely than their Asian, White and Latino peers above the poverty line to live in higher need communities.

How is this report used?

The geographic dimensions of community need can help inform many aspects of DHS’s strategic planning and resource allocation decisions, such as decisions on where to locate Family Centers or new after-school programs.

Where can I go for more information?

For more information, you can read previous reports below. Or you can reach out to DHS-Research@alleghenycounty.us with any questions.

 

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Previous reports in this series 

• 2018 update (all county)
  • 2018 Storymap
• 2014 update (suburbs)
• 2012 update (suburbs)
• 2000-2009 (suburbs)
• 2000-2012 (city)

Previous datasets in this series

• 2018 (all county)
• 2014 (suburbs)
• 2000-2012 (city)

County human services includes programs from over 300 community-based agencies and is delivered by social workers, peers, and outreach staff working all throughout the county. These staff run out-of-school-time programs, answer hotlines, investigate reports of potential harm to children and vulnerable adults, deliver meals to seniors and run Senior Centers, make home visits to families with newborns, and do the administrative work that makes our human services run efficiently.

What is this report about?

This report highlights the 2023 accomplishments that stood out. There are many, many other achievements that people told us about. We chose the ones that made the biggest difference.

The Allegheny County Department of Human Services (DHS) conducted a study of the involuntary hospitalization program in the county. Involuntary hospitalizations occur when an individual undergoing a psychiatric episode is deemed to be a clear and present danger to themselves or others.  The specific section that governs the intake process of an individual is Section 302 of the Mental Health Procedures Act (MHPA), and for that reason the entire program is sometimes called the 302 program.

Evaluations occur in a hospital setting. Following an upheld commitment individuals can initially be detained for up to 120 hours, with the potential for extensions. The county seeks to understand the system in detail and improve outcomes among individuals who go through this process.

What is this report about?

This report describes individuals who went through the involuntary hospitalization program from 2015-2022. The analysis profiles the individuals including their characteristics such as diagnosis, their usage of mental and behavioral health services, and their outcomes post release. 

What are the takeaways?

• Involuntary hospitalizations are common, affecting over 3,700 residents each year. The most common source of referrals occur from friend / family (43%), police officers (19%), and physicians (14%).
• Individuals who are involuntarily hospitalized have poor outcomes upon release—within 5 years of their first evaluation, fully 20% of the population has died, a rate that is higher than that for clients exiting jail, enrolling in homeless shelters, or receiving food assistance (SNAP) as well as the rate for individuals with severe mental illness (SMI) diagnoses.
• We find worse outcomes among 302 individuals with a pre-existing substance use disorder (SUD)— 5% of those with SUD 18–50 years of age die within two years of intake, compared to 2.5% of the 18–50-year-olds without SUD. Of those with SUD, eighty percent (60%) of the mortality rate is attributable to drug overdose.
• We found similarly elevated risks for other adverse outcomes. Over 23% were charged with a crime within 5 years of release, and 60% used an emergency department (ED) within one year of release.
• Statistical methods can distinguish between riskier and less risky clients with high fidelity at the moment of the 302 evaluation.
• Those petitioned for involuntary commitment were disproportionately Black, although petition-upheld rates are similar across race. A similar picture emerges for gender—men were more likely to be petitioned, but upheld rates at the point of exam were similar for men and women.

How is this report being used?

The report serves as an initial analysis into the involuntary hospitalization process. The county is using this analysis, as well as planned subsequent ones that look at the impact of an involuntary hospitalization on a person’s outcomes, and input from clinicians and community members to develop recommendations to improve care for this vulnerable population. Ultimately the county is looking to improve both the process and the outcomes for individuals who experience an involuntary hospitalization.

What information about overdose deaths is available?

How is this data used?

Data on victims and potential risk factors can help County government and other stakeholders implement evidence-based strategies to address the ongoing opioid epidemic. The reports, maps and dataset are provided in an effort to inform and stimulate discussion about substance use treatment and prevention.

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Related materials

Previous reports about accidental overdose

• 2015-2016 data
• 2008-2014 data

Dataset

• Overdose deaths by Allegheny County municipality: 2008-2014

Maps

• Cumulative County Overdose Deaths: 2008-2017 (interactive heat map)
• County Overdose Deaths: 2015-2016 (static heat map)
• By Pittsburgh City Council District: 2015-2016, 2008-2014
• By Allegheny County Council District: 2008-2014
• By Allegheny County Municipality: 2015-2016, 2008-2014
• By Pittsburgh Neighborhood: 2015-2016

Throughout the United States, people experiencing behavioral health challenges are overrepresented in the criminal justice system and Allegheny County is no exception. To better understand the state of our current system and to learn more about promising approaches in other jurisdictions, Allegheny County sought an independent evaluator to conduct a study. From among a number of proposers, the county selected researchers from the University of Pittsburgh who interviewed dozens of stakeholders, analyzed justice system data, examined models from other jurisdictions, and solicited feedback through a series of workshops.

Click on the links above to learn more about the researchers’ findings and recommendations:

One way that Allegheny County promotes the provision of high quality behavioral health services is through value-based contracting (VBC), which pays providers of behavioral health services based on quality of care rather than quantity of care. This type of contracting can reduce system costs while also providing financial incentives for high-performing providers. The Pennsylvania Department of Human Services (PA DHS) has implemented a series of VBC requirements for the Medicaid-funded behavioral health program statewide. This report outlines these requirements, highlights Allegheny County’s various VBC initiatives, and discusses next steps.

Click here to read the report.