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      System Transformation under the California Mental Health Services Act: Implementation of Full Service Partnerships in Los Angeles County

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          Abstract

          Objective

          The objective is to evaluate the effect of California’s Mental Health Services Act on the structure, volume, location, and patient-centeredness of Los Angeles County public mental health services.

          Methods

          This prospective mixed-methods study (2006-2013) is based in 5 Los Angeles County public mental health clinics, all with usual care and 3 with Full Service Partnerships (FSP): new MHSA-funded programs designed to “do whatever it takes” to provide intensive, recovery-oriented, team-based, integrated services for clients with severe mental illness. Study participants include treatment providers (42 FSP, 130 usual care) and clients (174 FSP, 298 usual care). FSPs were compared to usual care on outpatient services received (claims data) and organizational climate, recovery orientation, and provider-client working alliance (surveys; semi-structured interviews), with regression adjustment for client and provider characteristics.

          Results

          FSP clients received significantly more (5,238 vs. 1,643 minutes, p<.001), and more-frequently field-based (22% vs. 2%, p<.001), outpatient services than usual care clients in the first year post-admission. FSP clients reported more recovery-oriented services (RSA-R 3.8 vs. 3.5, p<.001) and better provider-client working alliance (WAI-S 3.8 vs. 3.6, p=.01). FSP providers reported more stress (55.0 vs. 51.3, p<.001) and lower morale (48.1 vs. 49.6, p<.001).

          Conclusions

          Los Angeles County’s public mental health system was able to transform service delivery in response to well-funded policy mandates. For providers, a structure emphasizing accountability and patient-centeredness was associated with greater stress, despite smaller caseloads. For clients, service structure and volume created opportunities to build stronger provider-client relationships and address client needs and goals.

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          Author and article information

          Contributors
          Journal
          9502838
          20145
          Psychiatr Serv
          Psychiatr Serv
          Psychiatric services (Washington, D.C.)
          1075-2730
          1557-9700
          1 June 2018
          01 February 2017
          01 June 2017
          18 June 2018
          : 68
          : 6
          : 587-595
          Affiliations
          University of California, Los Angeles-Semel Institute, CHS 33-251 Box 951759, Los Angeles, California 90095
          Los Angeles County Department of Mental Health, Los Angeles, California
          University of California, Los Angeles-David Geffen School of Medicine, Los Angeles, California
          University of California, Los Angeles-Semel Institute, Los Angeles, California
          University of Oklahoma-Center for Applied Social Research, Norman, Oklahoma
          University of California, Los Angeles-Semel Institute, Los Angeles, California
          Westat-Health Studies, Rockville, Maryland
          University of California, Los Angeles-Semel Institute, Los Angeles, California
          University of California, Los Angeles-Semel Institute, Los Angeles, California
          University of California, Los Angeles – History, Los Angeles, California
          West Los Angeles Veterans Administration Healthcare System-Desert Pacific MIRECC, Los Angeles, California
          University of Southern California- Social Work, 1150 S Olive Street, Suite 1423 1150 S Olive Street, Suite 1423, Los Angeles, California 90089
          University of California, Los Angeles-Semel Institute, 760 Westwood Plaza, Los Angeles, California 90024
          University of Southern California- Social Work, Montgom. Ross Fisher Bldg-214 Univ. Park MC-0477, Los Angeles, California 90089
          University of California, Los Angeles-Psychiatry and Biobehavioral Sciences, Box 71579 760 Westwood Plaza, Los Angeles, California 90024
          University of California, Los Angeles – History, Los Angeles, California
          Article
          PMC6005368 PMC6005368 6005368 nihpa971343
          10.1176/appi.ps.201500390
          6005368
          28142386
          7ec61b7a-14b8-408e-ac2f-7904dcf312b6
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          Article

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