Community Need Index

Current dataset and related materials

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.

 


Previous reports in this series 

Previous datasets in this series

DHS Goals and Key Initiatives: 2024

Current information

DHS has set five goals to guide us and our partners in serving our community well. We aim for our network for human services to improve access to care, prevent overuse of coercive services, prevent harm, increase economic security and ensure quality.

What is this report about?

DHS can reach our goals more quickly if we devote time and attention to several big, bold initiatives that will make our systems and our organization work better for everyone we serve. This document outlines our key initiatives in 2024—which are in addition to our core work of running effective systems of care for people.

DHS 2023 Accomplishments

Current information

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.

Current Information

Allegheny County DHS sends text messages to county residents for a variety of reasons, including increasing awareness of services, providing timely reminders, and gathering feedback after a service experience.  In addition, DHS uses this information to help evaluate and monitor programs it delivers.  This dashboard displays information about these outreach and engagement efforts, including the subject and purpose of these and the rates of engagement.  Data on DHS’s texting efforts are available from November 2017 to the present.

The dashboard allows users to examine DHS text messaging as a whole as well as drill down to individual text campaigns.  It allows users to understand the purpose of each campaign, the number of messages sent and the demographics of the people being contacted by each campaign.  DHS collects this information through Community Connect Labs (CCL), DHS’s texting software, and information is updated daily. Click here for a more detailed report on DHS’s texting outreach from 2018-2022.

Current Information

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.

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.

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 AHA tool:

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

Allegheny County Opioid Settlement Projects

Current Plan and Related Documents

Overview: 

Beginning August 31, 2022, Allegheny County received its first payment related to the settlement of litigation against manufacturers, distributors, and associated consultants for the opioid industry. Together, the litigation settlement will yield $82 million in total payouts to Allegheny County through December 2038.

Analysis: 

The report lists the summary of the planned investments. Additional analysis and information will be added as it becomes available.  The dashboard provides additional information about the fund and the initiatives the money is supporting.

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

Frequent Utilizers of Services in Allegheny County

What are these reports about?

Nationally and locally, policymakers and practitioners are interested in the people who frequently use publicly funded services, particularly crisis services. Most people who use crisis services do so infrequently during a year. A small number of people, however, use crisis services frequently, and sometimes they use more than one type of crisis service.

Allegheny County’s rich integrated data allows us to look at the people who use crisis services. This report summarizes key findings about the people who were involved with one or more of the following four crisis services in the years 2016 through 2017: hospital emergency departments, emergency homeless shelters, mental health crisis programs, and the criminal justice system. This summary report will be followed up by reports examining each of these four service areas in more detail.

What are the takeaways?

  • Of the people who used at least one of the four crisis services examined, 6% (10,655) met the definition of frequent users in at least one system. They accounted for 26% of all service episodes during this period.
  • There is little overlap between frequent utilizers of one type of crisis service and another. Just 9% of users were frequent in multiple systems. This does not mean they didn’t use other services, just that they were not frequent users of those systems.
  • Nonetheless, 26% of frequent users of mental health crisis services were also frequent users of hospital emergency departments, indicating that the emergency room might be a point of intervention for people in mental health crisis.
  • All frequent users of emergency shelter were connected to other human services prior to their first shelter stay during this period. This overlap suggests that although frequent utilizers of emergency shelters were connected to supports, the reasons behind people’s continued use of shelter were not adequately addressed through the services they were receiving.

Black residents are using crisis services at disproportionately high rates, and the disproportionality is more pronounced when looking at frequent utilizers. While 13% of the Allegheny County population is Black, 42% of people who used crisis systems (both frequent and non-frequent) were Black, and 49% of frequent utilizers were Black.

How is this report used?

This work is meant to be exploratory and descriptive in nature to help continue and expand the conversation about how we look at frequent utilizers and potential interventions going forward. By looking more closely at this population of frequent utilizers, we hope to gain insight into their needs, identify key intervention points, and find ways to encourage long-term wellness while reducing the need for repeat intense service usage.

Where can I go for more information?

For questions or suggestions, please reach out to DHS-Research@alleghenycounty.us

Current report and dashboard

What information about overdose deaths is available?

  • A report describes accidental overdose deaths that occurred in Allegheny County from January 2016 through June 2020 with a look at trends in numbers of deaths, demographics, and substances involved, like opioids and fentanyl.
  • An interactive dashboard provides data from 2008 and allows users to filter data for a closer look at particular years, substance types, demographic groups, and neighborhoods. The dashboard also provides information about fatal and non-fatal overdoses that resulted in hospital emergency department visits or administration of naloxone by EMS.

The report and dashboard are joint efforts of the Allegheny County Department of Human Services (DHS) and the Allegheny County Health Department (ACHD), present an analysis of deaths resulting from opioid overdose.

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.


Related materials

Previous reports about accidental overdose

Dataset

  • Overdose deaths by Allegheny County municipality: 2008-2014

Maps

 
Access the reports

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.

Suicide Data, 2002–Present: Interactive Dashboard

Access the dashboard

The dashboard below displays information about Allegheny County suicides since 2002. View trends in yearly suicides, demographics of people who died by suicide, and locations within the county. The data is updated monthly.

A related data brief is also available.

Problems viewing the dashboard? You can view it directly here.


Related materials

Allegheny County Suicides, 2008–2017: Data Brief

Suicide rates have been rising in nearly every state in the U.S. in recent years, and in Pennsylvania and Allegheny County, suicide rates are higher than the nation’s. This data brief explores Allegheny County suicide trends since 2008 as well as demographics, causes of death, and publicly funded service usage of those who died.

Click here to view the data brief.

Click here to view a related interactive dashboard.

In 2016, the Allegheny County Jail began offering naloxone, a life-saving medication that rapidly reverses opioid overdose, to people exiting the jail. Since then, the jail has distributed over a thousand naloxone kits. This data brief describes the naloxone distribution program and provides information on the people who received naloxone, including their demographics, the communities they lived in after leaving jail, and how many died of an overdose following their release from jail.

Click here to read the data brief.