BHSOAC
InitialStatewidePriorityIndicatorReport Ucla
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Mental Health Services Act Evaluation:
Initial Statewide Priority Indicator Report
Contract Deliverable 2E, Phase II
UCLA Center for Healthier Children, Youth and Families
EMT Associates, Inc.
Submitted on July 30, 2012
The following report was funded by the
Mental Health Services Oversight and Accountability Commission.
INVITATION: Stakeholder Feedback
As with all deliverables related to this contract, comments from stakeholders, including the
mental health service community at large are invited in response to this draft report to
ensure that the report reflects a balanced representation of the system and its consumers.
The UCLA‐EMT Evaluation Team welcomes general comments and responses to this report
the accompanying guidance document located at the following link:
https://acsurvey.qualtrics.com/SE/?SID=SV_3ZXXq73kNvERCle
Given the large number of readers who will review this report, we ask for concise feedback
that will help the evaluation team revise. The team would greatly appreciate comments
about the following topics:
• What indicators do you find more instructive, and why?
• What indicators do you find least instructive, and why?
• Analysis and Reporting Questions
o Do you have suggestions for alternate ways of computing specific indicators
presented in this report? Please provide explanation.
o Do you have suggestions for alternate ways of presenting specific indicators
presented in this report? Please provide explanation.
• Implications
o Do the indicators presented in this report provide an accurate representation
of consumer outcomes? If no, please explain.
o Do the indicators presented in this report provide an accurate representation
of mental health system performance? If no, please explain.
• General Comments
The feedback period will close on Tuesday, August 28. Following the close of the feedback
period, the evaluation team will incorporate, where possible, or note feedback in a revised,
final report – a statewide evaluation of the priority indicators for the Mental Health Service
Act (MHSA). This statewide evaluation report, updated with stakeholder input, will serve as
an initial effort to move toward ongoing monitoring of system performance focused on
improving quality of the mental health system.
The Evaluation Team thanks you in advance for your insights.
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Table of Contents
INVITATION: Stakeholder Feedback ............................................................................................................................... 1
OVERVIEW ............................................................................................................................................................................... 4
METHODS ................................................................................................................................................................................. 7
Findings Summary ............................................................................................................................................................. 14
ConsumerLevel Indicators: ........................................................................................................................................... 16
Priority Indicator: 1.1 – Average School Attendance per Year ............................................................................ 16
Priority Indicator: 1.2 Proportion Participating in Paid and Unpaid Employment ..................................... 21
Priority Indicator: 2.1 Homelessness and Housing Rates ..................................................................................... 24
Priority Indicator: 3.1 Arrest Ratio .............................................................................................................................. 27
Priority Indicator: 3.2 Proportion Incarcerated ...................................................................................................... 29
Priority Indicator: 4.1 Emergency Intervention for Mental Health Episodes ................................................ 30
Priority indicator: 4.2 Emergency Intervention for Cooccurring Physical Injury ....................................... 31
Priority Indicator: 5.1 Proportion Who Identify Family Support ....................................................................... 32
Priority Indicator: 5.2 Proportion who Identify Community Support .............................................................. 33
SystemLevel Indicators: ................................................................................................................................................. 34
Priority Indicator: 6.1 Demographic Profile of Consumers Served ................................................................ 34
Priority Indicator: 6.2 Demographic Profile of New Consumers ..................................................................... 37
Priority Indicator: 6.3 – Penetration of Mental Health Services ........................................................................ 40
Priority Indicator: 6.4 – Access to a Primary Care Physician .............................................................................. 43
Priority Indicator: 6.5 – Consumer / Family Perceptions of Access to Services ........................................... 45
Priority Indicator: 7.1 – FSP Consumers Served Relative to Planned Service Targets ............................... 47
Priority Indicator: 7.2 – Involuntary Status .............................................................................................................. 48
Priority Indicator: 7.3 – 24Hour Care ....................................................................................................................... 49
Priority Indicator: 7.4 – Consumer and Family Centered Care .......................................................................... 50
Priority Indicator: 7.5 – Integrated Service Delivery ............................................................................................ 52
Priority Indicator: 7.6 – Consumer Wellbeing ......................................................................................................... 55
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Priority Indicator: 7.7 – Satisfaction ........................................................................................................................... 57
Priority Indicator: 8.1 – Evidence Based or Promising Practices and Programs ......................................... 59
Priority Indicator: 8.2 – Cultural Appropriateness of Services .......................................................................... 62
Priority Indicator: 8.3 – Recovery, Wellness, and Resilience Orientation ...................................................... 65
Discussion: ConsumerLevel Priority Indicators ..................................................................................................... 68
Discussion: Mental Health System Performance Indicators ................................................................................ 69
Next Steps for the Evaluation ......................................................................................................................................... 73
Appendix A – California Counties that Participated in the Data Quality Assurance Report Exercise ..... 76
Appendix B – Account of Counties Included in Priority Indicator Calculations Requiring CSI or DCR Data ........... 77
Appendix C – Results from Verified and Unverified County Data ....................................................................... 88
Appendix D – Comparisons between Counties Responding to Data Quality Assurance Reports and
Declined/ Nonrespondents ........................................................................................................................................ 104
Appendix E – Priority Indicator Development Subsequent to Deliverable 2D ........................................... 107
Appendix F – CSI Service Function Variables for Hospitalization and NonHospitalization Designation
............................................................................................................................................................................................... 111
References ......................................................................................................................................................................... 116
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OVERVIEW
In 2004, California voters approved Proposition 63 – referred to as the Mental Health Services Act
(MHSA) – which was set forth to meet the following five broad goals using prevention and early
intervention programs:
(a) Define serious mental illness among children, adults and seniors as a condition deserving
priority attention, including prevention and early intervention services and medical and
supportive care.
(b) Reduce the longterm adverse impact on individuals, families and state and local budgets
resulting from untreated serious mental illness.
(c) Expand the kinds of successful, innovative service programs for children, adults and seniors
begun in California, including culturally and linguistically competent approaches for
underserved populations. These programs have already demonstrated their effectiveness in
providing outreach and integrated services, including medically necessary psychiatric services,
and other services, to individuals most severely affected by or at risk of serious mental illness.
(d) Provide state and local funds to adequately meet the needs of all children and adults who can
be identified and enrolled in programs under this measure. State funds shall be available to
provide services that are not already covered by federally sponsored programs or by
individuals’ or families’ insurance programs.
(e) Ensure that all funds are expended in the most cost effective manner and services are provided
in accordance with recommended best practices subject to local and state oversight to ensure
accountability to taxpayers and to the public.1
Thus, the MHSA is a multi‐faceted approach to consumer wellness and improved mental health
system functioning that fosters innovative programs, mental health awareness, and effective
treatment. The approach is sustained by state funding, and monitored and improved through
ongoing evaluation.
The current report contributes to ongoing MHSA evaluation through improving measurement of
outcomes at the consumer and system levels. The Mental Health Services Act Oversight and
Accountability Commission (MHSOAC) charged the UCLA‐EMT Evaluation Team with exploring
impacts of the MHSA on California’s mental health service system and its consumers. Part of this
effort is achieved by assembling several years of consumer intake, service, and consumer
satisfaction responses to document and assess mental health consumer outcomes and system
performance during the past several years. The goal of the current report is to document the
MHSA’s impact on the system and its consumers using existing data, which has been arranged into
target outcomes (referred to as priority indicators) that are of particular interest to the MHSOAC
and mental health service stakeholders.2 Per contract language, the evaluation team is to:
1 Text retrieved on December 20, 2011 from The California Department of Mental Health web site, located at
http://www.dmh.ca.gov/Prop_63/mhsa/docs/Mental_Health_Services_Act_Full_Text.pdf.
2 Stakeholder is broadly defined in the evaluation. Stakeholders include consumers (clients), consumers’ family members,
persons with “lived experience,” data analysts, service providers, mental health service organization staff and leadership,
and any person with a vested interest in mental health systems.
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Design and complete statistical analyses and reports that measure impact of MHSA at
individual and system levels on indicators specified in the Matrix of California’s Public Mental
Health System Prioritized Performance Indicators at the state and county levels. Draft
templates, documentation of analysis, and initial statewide reports will be circulated to key
stakeholders and made available to the public for input by posting on the web and making a
hard copy available upon request.
Individual client outcomes for full service partnerships (FSPs) by age group must be addressed
for each domain (education/employment, homelessness/housing and justice involvement) as
specified. Note: this impact analysis at the individual level is limited to available data (i.e., a
small segment of public mental health clients, full services partners, is reflected in this data.)
Mental Health system performance must address family/client/youth perception of wellbeing,
demographics of FSP population, FSP access to primary care, penetration rate and changes in
admissions for the entire public community mental health population, involuntary care, and
annual numbers served through CSS. (Workforce indicators will not be addressed through this
RFP.)
The priority indicators (referred in the above, italicized contract language as prioritized
performance indicators) are the key to the current evaluation; they were designed to assess how the
MHSA has impacted mental health consumers and the mental health system in target areas that
should be most changed through implementation of MHSA.
The process by which priority indicators were developed can be reviewed in earlier reports
available (http://healthychild.ucla.edu/MHSA_evaluation.asp). Advice from stakeholders was
adapted and this report examines if these adapted indicators provide meaningful information. This
report provides additional information on other potential indicators to determine if they add useful
and critical information. Decisions have not been made to change the previously approved priority
indicators. As such, this report represents a fundamental step in an ongoing process to refine and
potentially develop priority indicators that are not only measurable but useful to the variety of
stakeholders invested in this work.
Priority indicator development was a joint effort between the California Mental Health Planning
Council, MHSOAC, stakeholders, and the evaluation team. The evaluation team facilitated
discussions between interested stakeholders to create the strongest, most comprehensive
representations of priority indicators that both aligned with early conceptualizations and feedback
using the data that was already collected across the state with some regularity. Where gaps existed,
the evaluation team proposed new data collection that will improve future evaluation, but is
beyond the evaluation team’s current scope of work. Details of the priority indicator development
process are provided in the Background and Methods sections, below.
Background
The evaluation team completed fundamental groundwork before arriving at this report. To date,
the team has documented evaluation planning in four reports:
• Defining Priority Indicators – Identifies and defines priority indicators, through exploration of
the indicators proposed by the California Mental Health Planning Council1 to assess target
outcomes of mental health consumers and the performance of the mental health system.
• Defining Priority Indicators (revised) – The initial report was revised to include information
regarding the comprehensiveness and appropriateness of indicators, gather through a two‐
phase stakeholder feedback process. First, the initial report was posted to UCLA and MHSOAC
web sites for public review. The team welcomed general comments through an open call for
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feedback. A guidance document that included specific questions regarding the initial report’s
content and accessibility was also included with the report to aid review. In the revised report,
the evaluation team illustrated how stakeholder feedback was integral to indicator
development. Further, the team requested that readers alert their peers and clients to the
report to broaden the diversity of feedback. Second, the evaluation team hosted online
orientations to the report (webinars) with two stakeholder groups further explaining the
report’s purpose and the type of feedback sought. The call for feedback was open for just over
four weeks.
• Compiling Data to Produce all Priority Indicators – Proposes measurement methods for priority
indicators and how they can be computed/calculated primarily utilizing existing data. The
report also details potential data sources and specific variables or data fields, which can be
utilized to build comprehensive indicators of mental health consumer outcomes and system
performance.
• Compiling Data to Produce all Priority Indicators (revised) – The initial report was revised to
include information regarding measurement methods and the adequacy of existing data
sources, gathered through a similar stakeholder feedback process to that which followed the
Defining Priority Indicators report (i.e., public dissemination, accompanying report feedback
guidance document, presentations, webinars).
The current report takes another step to document statewide priority indicator development
through the initial analysis of existing data for fiscal years 2008‐09 and 2009‐10. Through the
analysis process, some proposed data sources or methods of indicator calculation, put forward in
previous reports by stakeholders and the evaluation team, were found to not be feasible or
meaningfully analyzable, due to limitations of data formatting or availability. Priority indicator
learning and development leading up to the current report are detailed in Appendix E.
The following table outlines priority performance indicators modified by the stakeholder review
process. Given the current status of data, not all indicators were possible for this report. These
challenges are explained throughout the document.
Table 1. Priority Indicators
CONSUMERS EVALUATED
CONSUMER‐LEVEL INDICATORS
SERVICE
POPULATION
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NERDLIHC
YAT
STLUDA
STLUDA
REDLO
Domain 1: Education/ Employment
Indicator 1.1. Average school attendance per year All Consumers x x
Indicator 1.2. Proportion Participating in Paid and Unpaid Employment FSP Consumers x x x
Domain 2: Homelessness/Housing
Indicator 2.1. Homelessness and Housing Rates All/FSP Consumers x x x x
Indicator 2.2. Proportion housed/ not homeless annually All/FSP Consumers x x x x
Domain 3. Justice Involvement
Indicator 3.1. Arrest Rate FSP Consumers x x x x
Indicator 3.2. Proportion Incarcerated All/FSP Consumers x x x x
Domain 4. Emergency Care
Indicator 4.1. Emergency Intervention for Mental Health Episodes All Consumers x x x x
Indicator 4.2. Emergency Intervention for Cooccurring Physical Injury n/a
Domain 5. Social Connection
Indicator 5.1. Proportion Who Identify Family Support n/a
Indicator 5.2. Proportion who Identify Community Support n/a
CONSUMERS EVALUATED
SYSTEM‐LEVEL INDICATORS
SERVICE POPULATION
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NERDLIHC
YAT
STLUDA
STLUDA
REDLO
Domain 6. Access
Indicator 6.1. Demographic Profile of Consumers Served All/FSP Consumers x x x x
Indicator 6.2. Demographic Profile of New Consumers All/FSP Consumers x x x x
Indicator 6.3. Penetration of Mental Health Services All Consumers x x x x
Indicator 6.4. Access to a Primary Care Physician FSP Consumers x x x x
Indicator 6.5. Consumer / Family Perceptions of Access to Services All Consumers x x x x
Domain 7. Performance
Indicator 7.1. FSP Consumers Served Relative to Planned Service
FSP Consumers x x x x
Targets
Indicator 7.2. Involuntary Status All Consumers x x x x
Indicator 7.3. 24Hour Care All/FSP Consumers x x x x
Indicator 7.4. Consumer and Family Centered Care All Consumers x x x x
Indicator 7.5. Integrated Service Delivery FSP Consumers x x x x
Indicator 7.6. Consumer Wellbeing All Consumers x x x x
Indicator 7.7. Satisfaction All Consumers x x x x
Domain 7. Structure
Indicator 7.1. Evidence Based or Promising Practices and
FSP Consumers x x x x
Programs
Indicator 7.2. Cultural Appropriateness of Services FSP Consumers x x x x
Indicator 7.3. Recovery, wellness, and Resilience Orientation FSP Consumers x x x x
The report is organized by the following topics:
1. A description of methods used, including data sources, limitations, and data preparation
procedures
2. Priority indicator analyses and findings
3. Discussion and implications of priority indicator findings
4. Next steps for the evaluation
METHODS
Priority indicators presented in the current report – built upon the California Mental Health
Planning Council’s indicator proposal and approved by the MHSOAC2 – were further developed
through consideration of MHSOAC needs and goals, assessment of existing state and county data
sources, and their measurement quality. Revised priority indicators were disseminated for
stakeholder feedback.3 As directed by the MHSAOC, priority indicators were created using existing
data sources that are systematically collected and reported by California counties, the California
Department of Mental Health (DMH), and other state institutions or offices.
Data Sources
Client & Service Information (CSI)
The CSI system is a repository of county, client (e.g., age, gender, preferred language, education,
employment status, living arrangement, etc.), and service information (number and length of
service contact). The data is collected from all consumers who receive mental health services,
including consumers involved in the Full Service Partnership.
Data Collection and Reporting (DCR) System
The DCR system houses data for consumers who are served through Full Service Partnership
programs. Data from assessments – the Partnership Assessment Form (PAF), Key Event Tracking
(KET), and Quarterly Assessment (3M) – are collected for consumers in specific age categories. The
PAF reflects consumer history and baseline information, including consumer education and/or
employment, housing situation, legal issues, health status, and substance use. The KET reflects any
important changes in the consumer’s life such as housing, education and/or employment, and legal
issues during full service partnership. The 3M is used to collect information quarterly on key areas
such as education, health status, substance use, and legal issues.
Performance Outcomes and Quality Improvement (POQI) – Consumer Perception Surveys (CPS)
These consumer surveys are customized for consumer groups (e.g., youth, adults, and older adults)
with access to mental health services. Instruments are composed of widely validated measures such
as the Child Behavior Checklist, Youth Self Report, and Restrictiveness of Living Environment Scale
for youth assessment; the Global Assessment of Functioning, Behavior and Symptom Identification
Scale, and the California Quality of Life for adults; and the Brief Symptom Inventory, Senior
Outcomes Checklist 10, and Index of Independent Activities of Daily Living for older adults. The
data, designed to inform treatment planning and service management, are collected from
individuals with “serious, persistent” mental illness who have received services for 60 days or more
and are not categorized as “medication only.” For FY 2008‐09 and prior years, a convenience
sampling approach was used wherein county level mental health service providers administered
surveys twice a year for a two‐week period, in early May and November. Investigation of the
convenience sampling methodology revealed the resulting information was not representative of
the larger mental health service population.4 Beginning with FY 2009‐10, representatives at the
Institute for Social Research at California State University at Sacramento designed a random
sampling methodology intended to produce data that is more representative of the perceptions of
the mental health service population. The random sampling method is currently under evaluation.
As such comparisons of CPS data between fiscal years cannot be made.
County MHSA Plans & Annual Updates
• Three Year Plans & Annual Updates
Counties are mandated to report Three‐Year Program and Expenditure Plans and Annual
Updates to plans. Three‐Year Program and Expenditure Plans and Annual Updates for FYs
2008‐09 and 2009‐10 were systemically reviewed for information regarding county planned or
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administered services, relevant to specific priority indicators, including:
(cid:131) Consumer Served through CSS
(cid:131) Client and Family Centered Care
(cid:131) Integrated Service Delivery
(cid:131) Evidence Based Practices and Programs
(cid:131) Recovery Wellness, and Resilience Orientation
The evaluation team coded planning or service activity information for relevance to each
domain, This coding process provided for descriptive analysis of differences in planned or
implemented service strategies statewide.
• Workforce, Education and Training (WET Plans)
Approved Workforce Education and Training (WET) Components of the Mental Health Services
Act Three‐Year Program and Expenditure Plans were available for fifty‐three counties. WET
plans were reviewed and coded for information regarding the following Priority Indicators:
(cid:131) Cultural Appropriateness of Services
(cid:131) Recovery Wellness, and Resilience Orientation
This coding process provided for descriptive analysis of county efforts to address the shortage
of qualified individuals to provide behavioral health care services.
Other Sources
• Estimates of Need for Mental Health Services
To achieve a standardized rate for penetration of services across all counties, the evaluation
team contracted with Dr. Charles Holzer for statewide and county mental health service need
estimates. Dr. Holzer previously developed penetration rate estimates for the California
Department of Mental Health. Specifically, he applied predicted probabilities from demographic
models to cross‐tabulations of Census population estimates. Holzer estimated the probability of
persons with serious mental illness using data from the National Comorbidity Survey
Replication and generated prevalence data estimates for several Census years and used the
most up‐to‐date National Comorbidity Survey data. (For additional information regarding
prevalence estimate methodology see Dr. Holzer’s website at
http://66.140.7.155/estimation/3_Synthetic/synthetic.htm).
• Involuntary Status
o Involuntary Status information (FY 2008‐09) was provided by DMH for the following
service categories: 72 hour Evaluation and Treatment (Adults, Children); 14 and 30‐day
Intensive Treatment; 180‐day Post Certification Treatment; and Temporary and Permanent
Conservatorships. Involuntary status data for FY 2009‐10 was not available from DMH as of
the preparation of this report.
Data Review & Verification Processes
Initial Review
To assess the quality and completeness of existing data sources, descriptive analysis was conducted
to explore the distribution of quantitative data fields and variation in qualitative (e.g., narrative)
information, between fiscal years, within counties, and across the state. This allowed the evaluation
team to work collaboratively with DMH representatives and county staff to explain unusual data
patterns (e.g., variation in completeness of information year to year, or differences in reporting
formats). The team maintained contact with key DMH staff and several county representatives (e.g.,
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Evaluation Advisory Group Members) throughout the analysis process, troubleshooting data
irregularities and limitations as necessary.
The review process also included merging consumer level data files from various sources to
determine the completeness of cases—whether a consumer’s information could be considered
complete across data sources and the target fiscal years (i.e., FY 2008‐09 and 2009‐10).
Data Quality Assurance Reports
Substantial variation (values and reporting patterns) was found between counties, within CSI and
DCR data fields identified for constructing priority indicators, during the data review period. These
findings, in addition to stakeholder feedback to our previous report about identifying data sources
for the statewide MHSA evaluation (see Mental Health Services Act Evaluation: Compiling Data to
Produce All Priority Indicators, November 2, 2011), demonstrated a need for the evaluation team to
provide county representatives an opportunity indicate the quality of key data and contextual
information needed for analysis, interpretation, and decisions based on this data.
The evaluation team provided MHSA coordinators and mental health service directors, within each
county and municipality with CSI or DCR data in state databases, with a Data Quality Assurance
Report on April 9, 2012. Reports displayed basic descriptive information for each CSI and DCR data
field the evaluation team previously identified as useful for constructing priority indicators. County
representatives had the option of indicating and explaining data quality online or by annotating the
report directly and returning it to the evaluation team.
Twenty‐eight counties and municipalities provided responses within six weeks of receiving their
Data Quality Assurance Report (see Appendix A for counties represented in the report). Responding
counties represented a broad cross‐section of the state (see Figures 1‐3, below). Responding
counties represent a majority of the state population, account for substantial proportions of most
MHSA regions, and represent the racial and ethnic diversity of the state (see Figures 1‐3). For
additional descriptive analysis of counties responding to Data Quality Assurance Reports, see
Appendix B.
Figure 1. Population of Counties Figure 2. Counties Responding/Not
Responding/Not Responding to Data Quality Responding to Data Quality Assurance
Assurance Reports Reports, by Region
9
6
13,727,70 23,233,95
5 (37.1%) 9 (62.9%) 2
10
10 11
7
2 1
Superior Central Bay Area Southern Los
Angeles
Declined/Non‐Respondents
Declined/Non‐Respondents Responding Counties
Responding Counties
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Figure 3. Race Dispersion of Counties Responding/Not Responding to Data Quality Assurance Reports
Stakeholder feedback to previous reports identifying data sources for the statewide MHSA
evaluation and to the county‐specific Data Quality Assurance Reports was generally consistent.
Responses across responding counties indicated that the majority of fields were accurate, however
few fields, such as Race and Ethnicity, received much more inconsistent evaluations of accuracy.
Data quality evaluations received from a cross‐section of the state greatly influenced the data
sources and data fields utilized, as well as the analysis and reporting decisions of the evaluation
team. The data review and verification process impacts this report most notably, as priority
indicators utilizing CSI or DCR data are presented separately in the findings summary for counties
who “verified” the accuracy of data underlying each priority indicator, and are reported in
Appendix C for those who did not. To note, although county representatives may verify its county’s
data, only some of the data may be deemed useful for inclusion in calculations for a given priority
indicator.
Data Considerations & Limitations
Overall, comparisons presented between and across fiscal years must be interpreted with caution
due to the completeness, reliability, and quality issues summarized above, and detailed in the
remainder of this section.
Missing / Unknown Data
All quantitative data sources and specific data fields utilized to compile priority indicators
contained some level of missing (e.g., no data reported) or unknown (e.g., data provided does not
conform to data system dictionaries) information. For indicators computed with underlying data
containing a substantial proportion of missing or unknown information (i.e., substantial enough to
potentially influence practical interpretation of indicators), the proportion of such information is
reported in narrative, tables, or figures.
Client & Service Information (CSI) and Data Collection and Reporting (DCR) Systems
Stakeholder feedback suggested inconsistency and potential inaccuracy among Race and Ethnicity
data fields may be due in part to changes in the format of these fields in the CSI and DCR data
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400,594,41
358,131,7
026,559,1
458,464 712,522 720,331
688,367,3
737,990,1
363,301
168,04
028,925,4
905,377,1 476,382,1
600,435
White Black or African American Asian Native Some Other Two or More
American Indian and Hawaiian and Race Races
Alaska Native Other Pacific
Islander
Responding Counties Declined/Non‐Respondents
systems. In 2006, DMH implemented changes to Ethnicity and Race fields due to Uniform Data
System/Data Infrastructure Grant (DIG) requirements from the Federal government (see DMH
Information Notice: 0602; April 18, 2006). Although DMH provided training about changes to these
data fields, Race and Ethnicity information seems to be reported with greater inconsistency across
counties, relative to other fields. Because demographic information in the CSI system is transferred
to corresponding fields in the DCR system, Race and Ethnicity information in both systems was
analyzed but interpreted with caution. To overcome potential shortcomings of this change, the
evaluation team used consumers’ pre‐DIG Race and Ethnicity information to replace blank fields in
their post‐DIG Race and Ethnicity fields, for all analyses involving demographic information.
Consumer Perception Surveys
For FY 2008‐09 and prior years, county level providers used convenience sampling, administering
Consumer Perception Surveys twice a year for a two‐week period in early May and November.
Investigation of the convenience sampling methodology revealed the resulting information was not
representative of the larger mental health service population.5 Beginning with FY 2009‐10, a
random sampling methodology was developed at the Institute for Social Research at California
State University at Sacramento, through which surveys are administered annually. This change in
sampling methodology was intended to produce data that is more representative of the perceptions
of the mental health service population. The random sampling method utilized is currently under
evaluation. Given the change in methodologies, comparisons of CPS data between fiscal years
cannot be made.
Data not Available in State Databases
Representatives from seven counties or municipalities that currently do not have data contained in
the DCR database for FY 2008‐09 or 2009‐10 were given the opportunity to provide data to the
evaluation team for key DCR fields noted in the data report. Of the counties not captured in the DCR
database, four representatives provided data within eight weeks of receiving the data quality
assurance report. This information was considered in analyses and preparation of this report. Other
county representatives who provided or may provide DCR data directly to the evaluation team
subsequent to June 8, 2012 will be considered for future reports.
Implications for Analysis and Reporting
The data review and verification process, stakeholder feedback, and the data considerations and
limitations (detailed in preceding sections) greatly influenced analysis and reporting decisions of
the evaluation team. This is most evident in the reporting format of priority indicators in this
report. Specifically for priority indicators involving CSI or DCR data reviewed by counties, results
are presented in the main body of this report for counties whose representatives “verified” the
accuracy of data underlying each priority indicator. This reporting format allows for presentation
and interpretation of indicators among counties whose representatives indicated confidence in the
underlying data. This format presents the most complete and informative picture of consumer
outcomes and system performance possible with current data. Results for other counties for which
data was not verified to build specific indicators are presented alongside counties for which data
was verified in Appendix C. Appendix C illustrates response results for all counties, including those
for counties whose representatives indicated a lack of confidence or did not respond to their
provided Data Quality Assurance Report.
Overall, priority indicator differences are relatively small between counties whose representatives
who provided verification of underlying data and those who did not. However, for indicators taking
into account fields such as Race or Ethnicity, priority indicator differences are frequently more
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pronounced due to the smaller number of county representatives indicating confidence in the
accuracy or completeness of these fields. Readers should be aware that these fields are considered
less reliable, complete, representative, or generally accurate by many counties, and as such
information presented from these fields may be less representative of the overall service
population, relative to other service information.
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Findings Summary
This section provides detailed findings about each priority indicator by domain (refer back to Table
1). CSI and DCR data presented for each priority indicator represent only counties whose
representatives verified the accuracy of all variables used to create each priority indicator. If a
county representative replied that one variable was inaccurate, then that county was not included
in analysis. To illustrate, counties with shaded rows, below, are included in the priority indicator
3.1 calculation. Thus, Butte, Calaveras, Contra Costa, Fresno, Lake, Los Angeles, Madera, Mariposa,
Napa, Placer, San Bernardino, San Francisco, Santa Clara, Sierra, Siskiyou, Solano, Trinity, Tulare,
and Tuolumne are included in the calculation. Counties indicating any variable necessary to
calculate indicator 3.1 as inaccurate, per review by county representatives, are not included in the
priority indicator 3.1 calculation. Refer to Appendix B for a full account.
Illustration: 3.1 Justice Involvement
Included in calculation
Not included in calculation
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The following summary captures findings from initial analysis existing data to produce priority
performance indicators. These findings are preliminary given the early stage of indicator
development. Readers will note that the evaluation team does not often make comparisons across
years given changes in data collection methodologies or the number of counties reporting relevant
data. In some cases, details are provided about priority indicators that could not be compiled due to
a lack of accurate, reliable, or complete existing data.
Using an iterative process, the MHSOAC will review these priority indicators and their outcomes to
work toward a complete and instructive set of priority performance indicators that best capture
MHSA impact on mental health service consumers and system performance. The following
summary provides guidance about the use of priority indicators—if they will be sustainable and
meaningful moving forward in regular evaluations.
15 |
ConsumerLevel Indicators:
Domain: Education and Employment
Priority Indicator: 1.1 – Average School Attendance per Year
Data Source: Consumer Perception Survey (Youth)
Counties/Municipalities Included: All
Priority indicator 1.1 was designed to be an account of how many days, on average, youth and TAY
consumers attended school during a school year. The evaluation team proposed calculating this
count using Consumer Perception Surveys (CPS) and Data Collection and Reporting (DCR) data. CPS
data provided an opportunity for the evaluation team to calculate counts of absentee days, which
more closely aligned with the intent of the indicator compared to DCR data. CPS data collected from
youth consumers and family members/caregivers was used to calculate the proportion of children
and TAY expelled or suspended from school. Youth and TAY responses collected during FY 2008‐09
and Family member/caregiver responses collected during FY 2009‐10 were used to calculate
proportions.
Figure 1.1 – 1. Proportion of Child and TAY Consumers Reporting Expulsion or Suspension (FY 2008
09)
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0% 13.2% 15.3%
9.3% 9.1%
10.0%
0.0%
Expelled or suspended Expelled or suspended
within the last 12 months since the beginning of
services
Children TAY
16 |
Figure 1.1 – 2. Proportion of Family Members/Caregivers Reporting Child or TAY Expulsion or
Suspension (FY 200809)
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
8.5% 9.3%
10.0%
0.0%
Expelled or suspended Expelled or suspended
within the last 12 since the beginning of
months services
Approximately 13% of child mental health consumers and 9% of TAY mental health consumers
reported expulsion or suspension within 12 months prior to completing a survey during FY 2008‐
09. During the same period, approximately 16% of children and 9% of TAY consumers reported
being expelled or suspended since initiating services. Family members/caregivers indicated that
approximately 9% of their youth (children and TAY) had been expelled during both target periods
(within 12 months and during the beginning of services).
Figure 1.1 3. Proportion of Family Members/Caregivers Reporting Child or TAY Expulsion or
Suspension (FY 200910)
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0% 13.9%
9.1%
10.0%
0.0%
Expelled or suspended Expelled or suspended
within the last 12 months since the beginning of
services
17 |
Family members/caregivers surveyed during FY 2009‐10 reported that 14% of youth (children and
TAY combined) were expelled or suspended during the last 12 months, and 9% of youth were
expelled or suspended since beginning services. Youth consumers did not complete a distinct
survey from family members/caregivers in FY 2009‐10. Consumer‐reported suspension or
expulsion provides some insight into the school attendance patterns of mental health consumers.
However, service information that directly tracks school attendance will provide a clearer picture
of the educational involvement of mental health consumers.
18 |
Data Source: Data Collection and Reporting (DCR)
Counties/Municipalities Included: Butte, Calaveras, Contra Costa, Fresno, Lake, Napa,
Placer, San Bernardino, Santa Clara, Siskiyou, Trinity, Tuolumne
(12 counties; 43% of counties responding to Data Quality Assurance Reports; 20% of all
counties)
The evaluation team’s data review revealed that calculations involving DCR data was less
meaningful than what CPS data yielded when interpreted. DCR data did not provide any count of
attendance or absentee days, rather it provided a general estimate (e.g., Always attends school
(never truant); Attends school most of the time; Sometimes attends school; Infrequently attends
school; and Never attends school). Without absolute values, it is not possible for the evaluation team
to determine the distinction between a youth who attends school “sometimes” or “infrequently,” for
example. The absence of counts in DCR data challenged the team’s ability to calculate an average;
calculating the recommended ratio (number of school attendance days during a consumer’s school
year divided by the number of days during a consumer’s school year) was not possible. Using DCR
data, the evaluation team calculated an alternative ratio – proportion of children and TAY who
attend school at least “most of the time.” That is, this ratio combined those who attended school
always and attended school most of the time.
Figure 1.1 – 4. Estimate of Youth Reporting “Always attends school” and “Attends school most of
the time” (FY 200809)
19 |
Figure 1.1 – 5. Estimate of Youth Reporting “Always attends school” and “Attends school most of
the time” (FY 200910)
According to DCR data from the 12 valid counties, 73% of children attended school at least “most of
the time” during FY 2008‐09 and FY 2009‐10. This proportion was lower for TAY among which
65% attended school at least most of the time. A similar pattern is seen for FY 2009‐10 data
wherein more children report attending school at least “most of the time” compared to TAY. One
possible reason for the discrepancy in the proportions between children and TAY is that there is
much more missing data (blank data cells) for TAY. For example, for FY 2008‐09, there is
approximately 78% missing data compared to 16% missing for children. Given that TAY
encompasses the ages of 16‐25, it is possible that the large proportion of missing data can be
explain by consumers over 18 years old who are no longer enrolled in secondary education
(wherein attendance is tracked). The ratios provide only a rough estimate of school attendance, as
it is not known what exactly the differences are between the five attendance categories.
20 |
Priority Indicator: 1.2 Proportion Participating in Paid and Unpaid
Employment
Data Source: Client & Service Information (CSI)
Counties/Municipalities Included (14): Butte, Fresno, Lake, Mariposa, Napa, Placer, San
Bernardino, Santa Clara, Santa Cruz, Siskiyou, Solano, Trinity, Tulare, Tuolumne
(14 counties; 50% of counties responding to Data Quality Assurance Reports; 24% of all
counties)
The proportion of employed TAY, adult, and older adult mental health consumers throughout the
state was calculated to identify how many consumers were employed throughout the state. These
ratios indicate the proportions of TAY, adults, older adults who were employed for pay at any given
point in time during each fiscal year.
Among the 12 counties that verified employment information, the proportions of employed TAY,
adults, and older adults for FYs 2008‐09 and 2009‐10 were low, with no more than 8% of consumer
employment for either year and for any age group (TAY, adults, older adults). During FY 2008‐09,
526 (97.7%) of employed TAY consumers, 1,760 (97.8%) of employed adult consumers, and 86
(90.7%) of employed older adult consumers held paid employment. During FY 2009‐10, 585
(98.3%) of TAY consumers, 1,602 (97.8%) of adult consumers, and 92 (90.2%) of older adult
consumers held paid employment.
Figure 1.2 1. Proportion of Employed Mental Figure 1.2 2. Proportion of Employed Mental
Health Consumers by Employment Type (FY Health Consumers by Employment Type (FY
200809) 200910)
3.0% 2.2% 9.3% 1.7% 2.3% 9.8%
100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 97.7% 97.8% 50% 98.3% 97.8%
90.7% 90.2%
40% 40%
30% 30%
20% 20%
10% 10%
0% 0%
TAY Adult Older Adult Tay Adult Older Adult
Consumers with non-paid employment Consumers with non-paid employment
Consumers with paid employment Consumers with paid employment
21 |
Data Source: Data Collection and Reporting (DCR)
Counties/Municipalities Included: Butte, Calaveras, Contra Costa, Fresno, Lake, Napa,
Placer, Santa Clara, Siskiyou, Trinity, Tulare, Tuolumne
(12 counties; 43% of counties responding to Data Quality Assurance Reports; 20% of all
counties)
The proportion of employed TAY, adult, and older adult Full Service Partnership consumers served
during FY 2008‐09 or 2009‐10 was calculated. These ratios indicate 1) the proportion of TAY,
adults, older adults who were employed, and 2) whether their employment was paid or non‐paid at
any given point in time during each fiscal year.
According to verified DCR data from 12 counties, 41 (6.5%) TAY consumers, 71 (5.5%) adult
consumers, and two (1.3%) older adult consumers were employed during FY 2008‐09. More than
85% of all employed consumers, across all age groups, held paid employment. As indicated by an
asterisk (*) in Figure 1.2‐1, a small proportion of employed TAY were more likely to hold paid and
non‐paid jobs simultaneously, which accounts for a total 105% employment rate. Employed adults
and employed older adults held either a paid job or a non‐paid job but not both. Fewer employed
consumers held paid employment during FY 2009‐10, compared to the previous year. Specifically,
the proportion of TAY and adult consumers with paid employment decreased by less than 4%.
Older adults, who had scant representation in the county verified data, maintained a 100% paid
employment rate.
Figure 1.2 3. Proportion of Employed FSP Consumers by Employment Type (FY 200809)
100%
90% 17.0% 11.3%
80%
70%
60%
50% 100%
40% 87.8% 88.7%
30%
20%
10%
0%
TAY* Adult Older Adult
Consumers with non-paid employment
Consumers with paid employment
22 |
Figure 1.2 4. Proportion of Employed FSP Consumers by Employment Type (FY 200910)
23 |
Domain: Homelessness and Housing
Priority Indicator: 2.1 Homelessness and Housing Rates
Data Source: Client & Service Information (CSI)
Counties/Municipalities Included: Butte, Calaveras, Contra Costa, Fresno, Kings, Lake,
Madera, Mariposa, Napa, Placer, San Bernardino, San Francisco, San Joaquin, Santa
Clara, Sierra, Siskiyou, Solano, Trinity, Tulare, Tuolumne
(20 counties; 71% of counties responding to Data Quality Assurance Reports; 34% of all
counties)
Rates of homelessness and housing were examined among all mental health consumers, and more
specifically among FSP consumers. Presented below are the rates of consumers identified as having
one of four housing statuses: unknown, independent,6 homeless, and foster. Most CSI consumers
accounted for in verified data had independent housing statuses, meaning that they resided in a
house or apartment with varying levels of support. Among all consumer age groups, housing
remained effectively unchanged. Rates of homeless child, TAY and older adult FSP consumers were
relatively low and highest among adult CSI consumers (see Figure 2.1 – 1 and 2.1 – 2). Among FSP
consumers, homelessness was more prevalent, particularly among adults and older adults. This
trend held true among FSP consumers across the target fiscal years (2008‐09 and 2009‐10).
As with all graphs in this report, “missing data,” or cells that were blank in datasets, are not
captured in illustrations. Thus, each age group shown does not sum to 100%.
Figure 2.1 1. Proportion of CSI Consumers’ Housing Statuses (FY 200809)
100.0%
4.8%
90.0%
13.7%
9.9%
12.5%
80.0%
70.0%
60.0%
Unknown
82.7%
50.0% Independent
74.8% 74.3% Homeless
40.0% 72.4%
Foster
30.0%
20.0%
10.0%
10.5% 2.7%
6.8%
3.2% 3.4%
0.0%
Child TAY Adult Older Adult
24 |
Figure 2.1 3. Proportion of CSI Consumers’ Housing Statuses (FY 200910)
100.0%
4.9%
90.0% 12.8%
9.7%
10.9%
80.0%
70.0%
60.0%
Unknown
50.0% 83.6% Independent
74.0%
75.3% Homeless
40.0% 73.9%
Foster
30.0%
20.0%
10.0%
9.5% 3.2% 8.3%
3.0% 3.8%
0.0%
Child TAY Adult Older Adult
25 |
Data Source: Data Collection and Reporting (DCR)
Counties/Municipalities Included: Butte, Calaveras, Contra Costa, Fresno, Kings, Lake,
Madera, Mariposa, Napa, Placer, San Bernardino, San Francisco, San Joaquin, Santa
Clara, Sierra, Siskiyou, Solano, Trinity, Tulare, Tuolumne
Figure 2.1 2. Proportions of FSP Consumers Homeless and Housed (FY 200809)
100.0%
90.0%
80.0%
70.0%
60.0% 43.1%
38.6% Unknown
50.0% 48.2% Independent
79.5%
Homeless
40.0%
Foster
30.0%
27.8% 32.3%
20.0% 11.8%
10.0%
14.2%
10.3%
7.3%
4.2%
0.0%
Child TAY Adult Older Adult
Figure 2.1 4. Proportions of FSP Consumers Homeless and Housed (FY 200910)
100.0%
90.0%
80.0%
70.0%
60.0% Unknown
50.5% 55.4% Independent
50.0% 58.0%
82.5% Homeless
Foster
40.0%
30.0%
20.0% 19.8%
11.1% 21.1%
10.0%
8.8% 9.0%
4.6% 4.8%
0.0%
Child TAY Adult Older Adult
26 |
Domain: Justice Involvement
Priority Indicator: 3.1 Arrest Ratio
Data Source: Consumer Perception Surveys (Youth, Youths’ Families, Adults, and Older
Adults)
Counties/Municipalities Included: All
Priority indicator 3.1 was designed to capture consumers who were arrested at any point during
the previous 12 months. The ratio is the number of total arrests during the fiscal year within an age
group by the total number of unique clients in that age group.
Arrest information contained in the Client & Service Information (CSI) system was indicated to be
inaccurate by most counties responding to the Data Quality Assurance Reports. Thus, CPS data was
used as an initial source to estimate arrest rates. The evaluation team examined available arrest
information from adult and older adult surveys to understand how often consumers were detained
within 12 months prior to completing the survey. The following outcomes are estimates from these
consumer reports. Outcomes indicate that each adult and older adult CSI consumer had <1 arrest
on average.
Only data from FY 2008‐09 is presented because the dataset provided a count of individual clients.
This was not possible with FY 2009‐10 data. Estimates are accurate to the extent that respondents
are willing to disclose their arrests.
Table 3.1 1. Arrest Rate Per CPS Survey Respondent/Consumer (FY 200809)
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0 0.05 0.02
0.0
Adults Older Adults
27 |
Data Source: Data Collection and Reporting (DCR)
Counties/Municipalities Included: Butte, Calaveras, Contra Costa, Fresno, Lake, Los
Angeles, Madera, Mariposa, Napa, Placer, San Bernardino, San Francisco, Santa Clara,
Sierra, Siskiyou, Solano, Trinity, Tulare, Tuolumne
(19 counties; 68% of counties responding to Data Quality Assurance Reports; 32% of all
counties)
Arrests occurring within 12 months of assessment were examined among FSP consumers served
during FY 2008‐09 and 2009‐10. Across both years, each consumer had <1 arrest. During this time,
TAY and Adults were more likely to experience arrest than children and older adults. Adults were
more likely to experience arrest than consumers in all other age (Figure 3.1 – 2).
Figure 3.1 2. Arrest Rate Per FSP Consumer
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0 0.4 0.1 0.5 0.2 0.2 0.5 0.1 0.2
0.0
Children TAY Adults Older Adults
FY 2008‐09 FY 2009‐10
28 |
Priority Indicator: 3.2 Proportion Incarcerated
Data Source: Client & Service Information (CSI)
Counties/Municipalities Included: Calaveras, Placer, Santa Clara, Santa Cruz,
Siskiyou, Solano, Trinity
(7 counties; 25% of counties responding to Data Quality Assurance Reports; 12% of all
counties)
Stakeholders proposed incarceration as a priority indicator, to further assess the rates of detention
among mental health consumers throughout the state. Currently there is scant incarceration data
about all mental health consumers exists, relative to data collected regarding arrests. Alternative
measures of incarceration in the CSI dataset include using conservatorship data for TAY consumers
(e.g., ward of the juvenile court) or legal class data, for example. However, feedback from
stakeholders, and review of existing data revealed limited reliability of currently collecting
information relevant to incarceration. Per stakeholders’ suggestions, the evaluation team seeks new
data collection to identify the number of consumers receiving services while incarcerated during
the fiscal year and the number of those who were incarcerated at any point during that same year.
29 |
Domain: Emergency Care
Priority Indicator: 4.1 Emergency Intervention for Mental Health
Episodes
Data Source: Client & Service Information (CSI)
Counties/Municipalities Included: Butte, Calaveras, Lake, Mariposa, Napa, Placer,
Santa Clara, Santa Cruz, Trinity, Tulare, Tuolumne
(11 counties; 39% of counties responding to Data Quality Assurance Reports; 19% of all
counties)
Limited intervention‐like services are tracked within the Client & Service Information (CSI) system.
Service types include crisis stabilizationemergency room, crisis stabilizationurgent care, adult crisis
residential, professional inpatient visit crisis intervention and the like—each that can be grouped as
“visits to a hospital” or “visits to a non‐hospital facility.” A list of facilities within each category is
located in Appendix F.) Mental health consumer visits to either a hospital or a non‐hospital facility
for mental health intervention was evaluated.
The evaluation team presents the average number of mental health consumers’ visit to a hospital
for mental health episodes in FY 2008‐09 or 2009‐10. Findings showed that all age groups use
emergency interventions at a similar rate. Further, trends show that consumers tend to use non‐
hospital facilities more often than hospitals.
Figure 4.1 1. Hospital Visits and Nonhospital Visits per CSI Consumer (FY 200809)
10.0
8.0
5.6 5.9
6.0 4.3
3.7
4.0
2.0 0.0 0.2 0.2 0.1
0.0
Children TAY Adults Older Adults
Proportion of Hospital Visits per Consumer Proportion of Non‐hospital Facility Visits per Consumer
Figure 4.1 2. Hospital Visits and Nonhospital Visits per CSI Consumer (FY 200910)
10.0
8.0 6.3
5.6
6.0 4.3
3.7
4.0
2.0 0.0 0.1 0.2 0.1
0.0
Children TAY Adults Older Adults
Proportion of Hospital Visits per Consumer Proportion of Non‐hospital Facility Visits per Consumer
Information with which to assess FSP consumers’ use of emergency intervention services for
mental health episodes was not available at the time of this report.
30 |
Priority indicator: 4.2 Emergency Intervention for Cooccurring Physical
Injury
The priority indicator “Emergency Intervention for Co‐occurring Physical Injury” was proposed by
stakeholders as a second and equally‐important way to assess how often mental health consumers
use emergency intervention (e.g., hospitals) for mental health needs. The reasoning was that some
physical injuries are related to – if not caused by – a change in mental health stability.
This priority indicator is key to comprehensively understanding consumers’ use of emergency
interventions (compared to a more substantial reliance on services that help consumers maintain
mental health on a regular basis). However, an account of hospital visits that specifically identify
physical injuries to mental health is currently unavailable to the evaluation team. The evaluation
team recommends additional examination of current CSI and DCR files that include hospital visit
variables to determine where it could be useful to note where hospital visits for physical injuries
are related to mental health.
31 |
Domain: Social Connections
Priority Indicator: 5.1 Proportion Who Identify Family Support
The priority indicator Social Connections was proposed by stakeholders as an addition to the
original proposed indicator set. As suggested in the report leading to this work, new data – the
number of family members that a consumer identifies as supportive – is required to calculate this
indicator.
32 |
Priority Indicator: 5.2 Proportion who Identify Community Support
Direct measures of consumer perceived support from non‐family members are not currently
available. As suggested in the report leading to this work, new data – specifically, the number of
non‐family members that a consumer identifies as supportive and the number of organizations that
a consumer visits voluntarily and regularly to receive appropriate and high quality services – are
required to calculate this indicator.
33 |
SystemLevel Indicators:
Domain: Access
Priority Indicator: 6.1 Demographic Profile of Consumers Served
Data Source: Client & Service Information (CSI); Data Collection and Reporting (DCR)
Counties/Municipalities Included: Butte, Calaveras, Contra Costa, Fresno, Lake, Los
Angeles, Madera, Mariposa, Napa, Placer, San Bernardino, San Francisco, San Joaquin,
Santa Clara, Santa Cruz, Sierra, Siskiyou, Solano, Stanislaus, Trinity, Tulare, Tuolumne
(22 counties; 78% of counties responding to Data Quality Assurance Reports; 37% of all
counties)
This indicator profiles mental health consumers overall and full service partners (FSPs) served
during FY 2008‐09 and 2009‐10. Service populations are presented by race/ethnicity, age, and
gender; these figures provide basic demographic descriptions of those receiving mental health
services across the state.
Figure 6.1 1. Race/Ethnicity of Mental Health Consumer
50.0%
42.2%
40.5%
40.0%
28.1% 30.2%
30.0%
20.0%
6.1% 6.0% 8.4% 8.5% 6.2% 6.6% 7.8% 7.1%
10.0%
0.1% 0.1% 1.1% 1.0%
0.0%
FY 2008‐09 FY 2009‐10
Figure 6.1 2. Race/Ethnicity of FSP Consumers
41.6%
50.0%
40.0% 34.0%
31.0% 26.5%
30.0% 19.0%
16.9%
20.0%
10.0% 3.5% 4.2% 0.1% 0.1% 5.4% 5.1% 2.0% 1.0% 4.9% 4.5%
0.0%
FY 2008‐09 FY 2009‐10
34 |
Among counties whose representatives verified race and ethnicity fields in CSI and DCR databases,
mental health consumers identified as Hispanic/Latino, Black, and Multiracial increased
proportionally, year‐to‐year (see Figure 6.1 ‐ 1). Asian FSP consumers increased proportionally,
year‐to‐year (see Figure 6.1 ‐ 2). These trends suggest minority groups are becoming a larger part
of the FSP and overall mental health service populations. However, a majority of counties providing
responses to Data Quality Assurance Reports did not verify the accuracy and completeness of their
race and ethnicity data. Additionally, a large proportion of FSP consumers were missing
Race/Ethnicity information in the DCR database. As such, the racial and ethnic breakdown of
mental health consumers during FY 2008‐09 and 2009‐10 must be interpreted with caution.
Counties with verified consumer age information in CSI and DCR databases show proportional
service increases among child, TAY and older adult mental health consumers (see Figure 6.2 ‐ 3)
and proportional service increases among child and TAY FSP consumers (see Figure 6.2 ‐ 4). Service
trends suggest these groups are becoming a larger part of their respective mental health service
populations.
Figure 6.1 3. Mental Health Consumers by Age
Group Figure 6.1 4. FSP Consumers by Age Group
50.0% 47.1% 60.0%
45.8% 50.7%
45.0%
50.0% 46.8%
40.0%
35.0% 29.5%
28.6% 40.0%
30.0%
26.0% 22.2%
25.0% 30.0%
20.0% 17.9% 18.1% 23.4% 20.4%
20.0%
15.0%
6.4% 6.5%
10.0% 10.0% 5.5% 5.0%
5.0%
0.0% 0.0%
Children TAY Adults Older Children TAY Adults Older
Adults Adults
FY 2008‐09 FY 2009‐10 FY 2008‐09 FY 2009‐10
35 |
Counties with verified gender data revealed the proportion of female and male mental health
consumers and FSP consumers remained steady, year‐to‐year.
Figure 6.1 5. Mental Health Consumers by Figure 6.1 – 6. FSP Consumers by Gender
Gender
52.7% 52.6% 55.0% 54.3%
47.3% 47.3%
50.0% 50.0%
42.4% 42.4%
40.0% 40.0%
30.0% 30.0%
20.0% 20.0%
10.0% 10.0%
0.0% 0.0%
FY 2008‐09 FY 2009‐10 FY 2008‐09 FY 2009‐10
Female Male Female Male
36 |
Priority Indicator: 6.2 Demographic Profile of New Consumers
Data Source: Client & Service Information (CSI); Data Collection and Reporting (DCR)
Counties/Municipalities Included: Butte, Calaveras, Contra Costa, Fresno, Kings, Lake,
Los Angeles, Madera, Mariposa, Napa, Placer, San Bernardino, San Francisco, San
Joaquin, Santa Clara, Santa Cruz, Sierra, Siskiyou, Solano, Stanislaus, Trinity, Tulare,
Tuolumne
(23 counties; 82% of counties responding to Data Quality Assurance Reports; 39% of all
counties)
The frequency and characteristics of new mental health consumers (i.e., those initiating services
within the FY) can provide insight into the changing makeup of the overall service population and
indicate the extent to which mental health disparities amongst un‐served and underserved
populations are reduced. Among counties that verified service date information in the CSI and DCR
systems, the proportion of new mental health consumers increased and the proportion of new FSP
consumers decreased year‐to‐year (see Figures 6.2 ‐ 1 & 6.2 ‐ 2).
Figure 6.2 1. New and Continuing Mental Health Figure 6.2 2. New and Continuing FSP
Consumers Served Consumers Served
100.0% 100.0%
92.7%
87.9%
80.0% 80.0%
63.4%
60.0% 60.0%
50.3%
49.7%
36.6%
40.0% 40.0%
20.0% 12.1% 20.0%
7.3%
0.0% 0.0%
FY 2008‐2009 FY 2009‐2010 FY 2008‐2009 FY 2009‐2010
Continuing Consumers New Consumers Continuing Consumers New Consumers
Bewteen FY 2008‐09 and 2009‐10, the proportion of new Hispanic/Latino, Asian, Black, and
Multirace mental health consumers increased (see Figure 6.2 ‐ 3). Among FSP consumers, the
proption of new Asian and Black consumers increased while all other racial/ethnic groups
decreased as a proportion of the new FSP service population, year‐to‐year.
37 |
Figure 6.2 3. Race/Ethnicity of New Mental Health Consumers
50.0%
41.1%37.6% 34.8%
40.0%
31.1%
30.0%
20.0%
10.0% 3.0% 3.4% 8.7% 8.5% 1.3%1.0% 7.4% 7.7% 7.3% 6.9%
0.1% 0.1%
0.0%
FY 2008‐09 FY 2009‐10
Figure 6.2 4. Race/Ethnicity of New FSP Consumers
60.0% 53.1%
50.0% 39.5%
40.0% 27.8%
30.0% 20.3% 18.4%
14.0%
20.0%
10.0% 3.1%3.7% 0.0%0.0% 4.2%4.6% 2.3%0.0% 4.7%4.3%
0.0%
FY 2008‐09 FY 2009‐10
Older adult, adult, and TAY consumers increased as a proportion of all new mental health
consumers, while TAY and children increased as a proportion of FSP consumers served between FY
2008‐09 and 2009‐10 (see Figures 6.2 ‐ 5 & 6.2 ‐ 6).
38 |
Figure 6.2 5. New Mental Health Consumers Figure 6.2 6. New FSP Consumers by Age
by Age Group Group ____
100.0% 100.0%
5.4% 8.4% 5.4% 4.0%
90.0% 90.0%
80.0% 80.0%
35.0%
70.0% 44.7% 70.0% 49.2%
49.7%
60.0% Older Adults 60.0% Older Adults
50.0% Adults 50.0% 24.7% Adults
TAY TAY
40.0% 17.8% 40.0%
Children 22.0% Children
30.0% 23.5% 30.0%
20.0% 20.0%
36.3%
31.1%
10.0% 18.4% 10.0% 23.5%
0.0% 0.0%
FY 2008‐09 FY 2009‐10 FY 2008‐09 FY 2009‐10
The gender figures for new mental health consumers and new FSP consumers held relatively
steady, year‐to‐year (see Figures 6.2 ‐ 7 & 6.2 ‐ 8).
Figure 6.2 7. Gender of New Mental Health Figure 6.2 8. Gender of New FSP Consumers
Consumers _________
100.0% 100.0%
90.0% 90.0%
80.0% 80.0%
49.2% 48.5% 49.4% 51.3%
70.0% 70.0%
60.0% 60.0%
50.0% Female 50.0% Female
Male Male
40.0% 40.0%
30.0% 30.0%
50.7% 51.4% 50.3% 48.3%
20.0% 20.0%
10.0% 10.0%
0.0% 0.0%
FY 2008‐09 FY 2009‐10 FY 2008‐09 FY 2009‐10
Mental health services or FY 2009‐10 served fewer new mental health consumers and new FSP
consumers than in the previous year; however, service to new minority mental health consumers
(e.g., Hispanic/Latino and Multirace) and new minority FSP consumers (e.g., Asian) increased, year‐
to‐year. Additionally, more new child and TAY consumers were served in FY 2009‐10 than in the
previous year.
39 |
Priority Indicator: 6.3 – Penetration of Mental Health Services
Data Source: Client & Service Information (CSI); Data Collection and Reporting (DCR)
Counties/Municipalities Included: Butte, Calaveras, Contra Costa, Fresno, Lake, Los
Angeles, Madera, Mariposa, Napa, Placer, San Bernardino, San Francisco, San Joaquin,
Santa Clara, Santa Cruz, Sierra, Siskiyou, Solano, Stanislaus, Trinity, Tulare, Tuolumne
(22 counties; 79% of counties responding to Data Quality Assurance Reports; 37% of all
counties)
Priority indicator 6.3 details the extent to which mental health services are reaching California
residents estimated to be in need of services.7 This metric provides indications of how well the
mental health system is meeting the level of need among various populations.8
Rate of penetration of service can be defined in a myriad of ways. As a result, the mental health field
lacks a standard penetration rate calculation and reporting format. For example, the National
Association of State Mental Health Program Directors’ (NASMHPD) penetration rate calculation
includes several outcome indicators such as: denial of care, consumer perception of access, and
utilization rates.9 Given this variation, penetration rate calculations using the same formula but
different data sources may produce very distinct results. To arrive at a rate of penetration of
services standardized across California counties, the evaluation team adopted Dr. Charles Holzer’s
methods for estimating need for mental health services.10 These methods are in line with those
previously employed by CADMH.
Specifically, predicted probabilities from demographic models were applied to cross‐tabulations of
Census population estimates.11 Estimations of persons with serious mental illness (SMI) were
derived utilizing data available from the National Comorbidity Survey Replication.12 Rates of
service among all mental health consumer, and specifically among race/ethnicity, gender, and age
groups were set against estimates of need for mental health services statewide, to arrive at rates of
penetration of services.
Figure 6.3 1. Penetration Services among those Estimated to be in Need
40.0% 36.1% 35.6%
30.0%
20.0%
10.0%
0.0%
FY 2008‐09 FY 2009‐10
Among counties that verified service data, more than one third of those estimated to be in need of
service (i.e., serious mental illness) were served in FY 2008‐09 and 2009‐10 (Figure 6.3 ‐ 1).
40 |
Figure 6.3 2. Penetration Services among those Estimated to be in Need, by Gender
50.0%
42.3% 41.7%
40.0%
31.0% 30.6%
30.0%
20.0%
10.0%
0.0%
FY 2008‐09 FY 2009‐10 FY 2008‐09 FY 2009‐10
Female Male
More males then females estimated to experience serious mental health illness were served in FY
2008‐09 and 2009‐10 (see Figure 6.3 ‐ 2). Within gender groups, rates of penetration of services
remained steady, year‐to‐year.
Among age groups, TAY mental health consumers overall and FSP consumers had the greatest
penetration of services during FY 2008‐09 and 2009‐10. Child mental health consumers and FSP
consumers had the lowest rate of service penetration. Within age groups, penetration rates
remained relatively stable, year‐to‐year (see Figure 6.3 ‐ 3).
Figure 6.3 3. Penetration Services among those Estimated to be in Need, by Age Group
50.0%
44.5% 43.7%
40.0%
33.9% 34.2% 33.7%
31.6%
30.0% 26.2% 26.9%
20.0%
10.0%
0.0%
FY 2008‐09 FY 2009‐10 FY 2008‐09 FY 2009‐10 FY 2008‐09 FY 2009‐10 FY 2008‐09 FY 2009‐10
Older Adult Adult TAY Child
41 |
Rates of service penetration were greatest among Black and American Indian mental health
consumer groups for FY 2008‐09 and 2009‐10. Penetration rates among White and Hispanic
racial/ethnic groups were also above fifty percent (see Figures 6.3 ‐ 4 & 6.3 ‐ 5).
Figure 6.3 4. Penetration Services among those Estimated to be in Need, by Race/Ethnicity (FY 2008
09)
200.0%
180.8% 151.8%
150.0%
91.0%
100.0% 67.7%
57.7%
50.0% 25.4% 16.1%
0.0%
White Hispanic Black Asian Pacific Islander American Other
Indian (includes:
Multiple,
Other)
Figure6.3 5. Penetration Services among those Estimated to be in Need, by Race/Ethnicity (FY 2009
10)
250.0%
217.1%
200.0%
165.6%
150.0%
71.5%
100.0%
57.5% 55.5% 22.5% 12.2%
50.0%
0.0%
White Hispanic Black Asian Pacific Islander American Other
Indian (includes:
Multiple,
Other)
42 |
Priority Indicator: 6.4 – Access to a Primary Care Physician
Data Source: Data Collection and Reporting (DCR)
Counties/Municipalities Included: Butte, Calaveras, Contra Costa, Fresno, Kings, Lake,
Los Angeles, Madera, Mariposa, Napa, Placer, San Bernardino, San Francisco, San
Joaquin, Santa Clara, Sierra, Siskiyou, Solano, Stanislaus, Trinity, Tulare, Tuolumne
(22 counties; 79% of counties responding to Data Quality Assurance Reports; 37% of all
counties)
Many mental health consumers view primary care as a cornerstone to their healthcare and look
towards general practitioners to assist with their mental health service provision.13 Primary care
providers, however, may be reluctant to offer such services due to lack of training and experience
related to mental illness. Proper training for general practitioners can mitigate this reluctance and
allow for mental health services to occur in primary care settings, thus positively impacting the
lives of several mental health patients.14
Including primary care with mental health care helps patients address their multiple needs in a
more systemic and holistic fashion. For instance, patients with mental illness (particularly
schizophrenia) often have poorer physical health relative to the general population.15 Primary care
facilities can offer a space for patients to address their multiple needs. This ensures that patients
receive all levels of needed services. Primary care physicians can provide wellness checks for
mental health care consumers, much in the same way that they do for diabetes patients.16
Moreover, coordination between the psychiatrist and primary care doctor is important to ensure
that there are no negative drug interactions.17 Therefore, access to primary care may help improve
recovery for mental health consumers.18 Further, consumers often will not accept referrals to
mental health providers, and in such cases primary care providers by default become the sole
practitioner treating a mental health consumer.19 Mental health consumers’ access to primary care
not only enhances recovery but often becomes the only treatment option for several patients. With
this context, indicator 6.5 provides indication of the level of primary care FSP consumers received.20
Figure 6.4 1. FSP Access to a Primary Care Physician
Overall FSP access to a primary care physician
60.0%
increased year‐to‐year (see Figure 6.4 ‐ 1).
48.8%
45.3%
50.0%
FSP access to a primary care physician increased
40.0% proportionally among TAY consumers but decreased
moderately among all other age groups (see Figure 6.4
30.0%
‐ 2).
20.0%
10.0%
0.0%
FY 2008‐09 FY 2009‐10
43 |
Figure 6.4 2. FSP Access to a Primary Care Physician, by Age Group
60.0%
52.2% 51.6%
40.0%
26.5% 26.2%
20.0% 14.8% 15.9%
6.6% 6.3%
0.0%
Child TAY Adult Older Adult
FY 2008‐09 FY 2009‐10
Figure 6.4 3. FSP Access to a Primary Care
Physician, by Gender
FSP access to a primary care physician increased
60.0%
53.3% 52.6% proportionally year‐to‐year among female
consumers but decreased among male consumers
50.0%
45.1% 45.4% (see Figure 6.5 ‐ 3).
40.0% Conversely, access to a primary care physician
increased among White, Hispanic/Latino, and
30.0% American Indian FSP consumers, but decreased
among Black FSP consumers, year‐to‐year (see
Figure 6.5 ‐ 4).
20.0%
10.0%
0.0%
Female Male
FY 2008‐09 FY 2009‐10
Figure 6.4 4. FSP Access to a Primary Care Physician, by Race/Ethnicity
35.0%
30.0% 27.6% 28.3% 29.4%30.4%
25.1% 23.2%
25.0%
20.0%
15.0%
10.0%
5.0% 5.9% 5.9% 1.1%1.2% 4.5% 4.5%
0.4%0.4%
0.0%
White Hispanic / Asian Pacific Black American Multirace
Latino Islander Indian
FY 2008‐09 FY 2009‐10
44 |
Priority Indicator: 6.5 – Consumer / Family Perceptions of Access to
Services
Data Source: Consumer Perception Surveys
Sample Analyzed: Consumer Perception Survey Respondents: All
Organizational, economic, and demographic factors have been found to influence consumer access
to mental health services. Specifically, changes in the treatment system that weaken or eliminate
public programs, overburden staff, or de‐emphasize quality standards can negatively affect
patients’ access to services.21 Rising health care costs are also shown to influence rates of mental
health service access along racial/ethnic or income based lines.22 Given this context of access to
appropriate mental health care services, consumer and family perceptions of access to care were
investigated. This provides a glimpse into the consumer understanding of the mental health care
system.
Data resulting from the FY 2008‐09 and 2009‐10 Consumer Perception Surveys were analyzed to
create aggregate mean ratings of perception of access to mental health services. Among family
members/caregivers and TAY respondents, ratings summarize perceptions of convenient service
location and available service times. Among adult and older adult respondents, ratings summarize
perceptions of the convenience of the location of services, the times services were available, staff
willingness to provide service, prompt staff response to calls, ability to receive all necessary
services, and ability to see a physician as needed. Five‐point response scales (i.e., 1 – Strongly
Disagree to 5 – Strongly Agree) were provided to respondents; thus, ratings of 3.5 or greater
generally indicate positive perceptions of access to services.
Figure 6.5 – 1. Consumer Perceptions of Access to Mental Health Services, FY 200809
Older Adult 4.28
Adult 4.18
TAY 3.99
Family Member/Caregiver 4.35
1 2 3 4 5
(See Appendix C, Table 6.5 ‐1 for response rates)
Figure 6.5 – 2. Consumer Perceptions of Access to Mental Health Services, FY 200910
Older Adult 4.05
Adult 3.81
Family Member/Caregiver 4.07
1 2 3 4 5
(See Appendix C, Table 6.5 ‐1 for response rates)
45 |
Aggregate ratings indicate that all consumer respondent groups (i.e., family/caregiver, TAY, adult,
and older adult) held positive impressions of their access to mental health services during both
fiscal years analyzed (see Figure 6.5 – 1 & 2). However, such trends must be interpreted with
caution, as the convenience sampling method employed to gather FY 2008‐09 data has been found
to not be representative of the entire mental health service population.23 Additionally, the random
sampling method employed during FY 2009‐10 is currently under evaluation.
Within racial/ethnic groups, ratings of access to services were highest among adult and older adult
Hispanic/Latino respondents in FY 2008‐09 and 2009‐10. Perceptions were relatively consistent
across respondent groups (see Table 6.5 ‐ 1).
Table 6.5 1. Consumer Perceptions of Access to Mental Health Services by Race/Ethnicity
Family Member/
TAY Adult Older Adult
Caregiver
FY FY FY FY FY FY FY FY
2008 2009 2008 2009 2008 2009 2008 2009
2009 2010 2009 201024 2009 2010 2009 2010
White 4.36 4.07 4.06 4.18 3.69 4.29 4.01
(n=13,035) (n=564) (n=7,782) (n=20,190) (n=842) (n=2,381) (n=1,345)
Hispanic / 4.38 4.12 4.04 4.27 3.95 4.44 4.20
Latino (n=17,783) (n=490) (n=4,700) (n=11,400) (n=227) (n=893) (n=414)
Asian 4.33 3.98 3.93 4.20 4.05 4.33 4.08
(n=1,211) (n=57) (n=1,004) (n=3,133) (n=181) (n=332) (n=465)
Pacific 4.34 3.70 4.01 4.24 3.76 4.08 3.69
Islander (n=476) (n=23) (n=487) (n=1,752) (n=26) (n=41) (n=8)
Black 4.34 4.06 3.97 4.22 3.80 4.28 4.01
(n=6,121) (n=160) (n=4,463) (n=6,627) (n=201) (n=472) (n=159)
American 4.32 4.06 4.01 4.14 3.62 4.26 3.87
Indian (n=1,742) (n=69) (n=1,748) (n=2,634) (n=108) (n=185) (n=114)
Ratings of access to mental health services were higher among female TAY and adult consumers,
but higher among male family members/caregivers (see Table 6.6 ‐ 2).
Table 6.5 2. Consumer Perceptions of Access to Mental Health Services by Gender
Family Member/
TAY Adult Older Adult
Caregiver
FY FY FY FY FY FY FY FY
2008 2009 2008 2009 2008 2009 2008 2009
2009 2010 2009 201025 2009 2010 2009 2010
Female 4.35 4.06 4.09 4.24 3.82 4.33 4.09
(n=13,052) (n=399) (n=10,176) (n=22,915) (n=934) (n=2,531) (n=1,586)
Male 4.37 4.08 3.95 4.19 3.80 4.31 3.97
(n=21,115) (n=653) (n=12,116) (n=18,486) (n=631) (n=1,574) (n=771)
Other 4.23 4.00 3.44 3.95 3.01 4.21 4.05
(n=26) (n=1) (n=101) (n=291) (n=4) (n=20) (n=7)
Overall, ratings suggest that on average, consumers held generally positive perceptions of their
access to services.
46 |
Domain: Performance
Priority Indicator: 7.1 – FSP Consumers Served Relative to Planned
Service Targets
Data Source: Data Collection and Reporting (DCR); County Plans / Annual Updates
Counties/Municipalities Included (22): Butte, Calaveras, Contra Costa, Fresno, Kings,
Lake, Los Angeles, Madera, Mariposa, Napa, Placer, San Bernardino, San Francisco, San
Joaquin, Santa Clara, Sierra, Siskiyou, Solano, Stanislaus, Trinity, Tulare, Tuolumne
(22 counties; 79% of counties responding to Data Quality Assurance Reports; 37% of all
counties)
The number of FSP consumers served annually through Community Services and Support (CSS)
programs relative to those who were targeted for service was examined to provide insight into the
extent to which service levels have met expectations. FSP service targets were systematically
collected from county three year plans and annual updates.
Among counties whose representatives verified their FSP service information, 29.5%
(14,332/48,642) of the statewide FSPs service target was met in FY 2008‐09 and 79.4%
(18,357/23,112) in FY 2009‐10. This improvement in the ratio of FSP consumers served to targeted
is reflective of increased service rates, as well as increasingly accurate county service targets, as
county’s CSS programs become more established.
Figure 7.1 1. FSP Consumers Served to Planned Service Target, by Age Group
140.0%
118.7%
113.9%
120.0%
100.0%
80.0%
61.7%
57.6%
60.0% 49.9%
34.8% 33.3%
40.0%
26.6%
20.0%
0.0%
Child TAY Adult Older Adult
FY 2008‐09 FY 2009‐10
Because CSS programs are often tailored to serve specific age groups, ratios of FSP consumers
served to those targeted for service were explored within age groups. Service ratios improved
among all age groups year‐to‐year. However, child and TAY service rates exceeded service targets
during FY 2009‐10. Again, this is attributable to increased service rates and more accurate service
targets.
47 |
Priority Indicator: 7.2 – Involuntary Status
Data Source: California DMH Reports – Involuntary Services, Seclusion, and Restraint
Counties/Municipalities Included: All
On July 1, 1969, the Lanterman‐Petris‐Short Act (LPS) became part of California’s Community
Mental Health Services Law.26 LPS resulted from statewide concerns regarding civil commitment of
the mentally ill. California conducted a two‐year review to redesign and improve involuntary care
procedures. In sum, persons deemed “gravely disabled” or dangerous to themselves or others may
enter the LPS involuntary care system.27
Involuntary status refers to a legal intervention designed for persons with severe mental illness
who are at risk for relapse and need ongoing care.28 Involuntary care proponents assert that such
services improve treatment adherence and may catalyze mental health services to mobilize and
improve rigor.29
Indicator 7.2 provides indication of the rate of involuntary status among all mental health
consumers, during FY 2008‐09.30 Seventy‐two hour evaluation and treatment services are the
starting point for persons entering the involuntary care services system, thus 72‐Hour services to
children and adults were among the highest reported. Moreover, 14‐day intensive treatments
immediately follow 72‐hour evaluations; therefore, these rates are also relatively high. Generally,
the service rate patterns displayed in Figure 7.2 ‐ 1 are reflective of the path mental health
consumers take through the involuntary services system.
Figure 7.2 1. Involuntary Status Per 10,000, FY 200809
Permanent Conservatorships 2.4
Temporary Conservatorships 1.2
180‐Day Post Certification Program 0.1
30‐day Intensive Treatment 1
Additional 14‐day Intensive (Suicidal) 0.1
14‐day Intensive Treatment 20
72‐Hour Evaluation and Treatment ‐Child 18.4
72‐Hour Evaluation and Treatment ‐Adult 48.6
48 |
Priority Indicator: 7.3 – 24Hour Care
Data Source: Client & Service Information (CSI); Data Collection and Reporting (DCR)
Counties/Municipalities Included: Butte, Calaveras, Contra Costa, Fresno, Kings, Lake,
Los Angeles, Madera, Mariposa, Napa, Placer, San Bernardino, San Francisco, San
Joaquin, Santa Clara, Santa Cruz, Sierra, Siskiyou, Solano, Stanislaus, Trinity, Tulare,
Tuolumne
(23 counties; 82% of counties responding to Data Quality Assurance Reports; 39% of all
counties)
Individuals with prolonged mental health related disability (examples include schizophrenia,
schizoaffective disorder, and bipolar disorder) utilize substantial mental health resources due to
the need for 24‐hour care.31 Twenty‐four‐hour care services vary by age group. Specifically, Skilled
Nursing Facilities and State Hospitals generally serve adults, older adults, and transition age youth
(TAY). Community Treatment Facilities (CTFs) and Rate Care Level 14 (RCL 14) serve children and
TAY. Mental Health Rehabilitation Centers (MHRCs) serve all populations yet separate children
from adults and older adults.
Rates of 24‐hour care can provide an indication of how well the mental health system is confronting
the challenges of providing such intensive services. The mental health consumers and FSP
consumers who received 24‐hour care during FY 2008‐09 and 2009‐10 are detailed below.
Figure 7.3 1. 24Hour Care Rates
Among counties that verified service data,
40.0%
33.8% 29.8% proportionally more mental health consumers but
30.0% fewer FSP consumers received 24‐hours services
during FY 2009‐10 than in the previous year (see
20.0%
Figure 7.3 ‐ 1).
10.0%
4.6% 4.8%
The proportion of mental health consumers receiving
0.0%
24‐hour services decreased among all age groups,
All Consumers FSP Consumers
year‐to‐year. In contrast, the proportion of child and
adult FSP consumers receiving 24‐hour care
FY 2008‐2009 FY 2009‐2010
increased during this period (see Figures 7.3 – 2 & 3).
Figure 7.3 2. Mental Health Consumers Figure 7.3 3. FSP Consumers Receiving 24
Receiving 24Hour Care, by Age Group Hour Care, by Age Group
80.0% 60.0%
71.3% 70.6% 54.2% 55.9%
70.0%
50.0%
60.0%
40.0%
50.0% 30.8%28.5%
40.0% 30.0%
30.0% 19.9% 18.9% 20.0%
1
2
0
0
.
.
0
0
%
%
4.4% 4.1% 5.4%5.3% 10.0%
7.9% 9.7% 7.1%5.8%
0.0% 0.0%
Child TAY Adult Older Child TAY Adult Older
Adult Adult
FY 2008‐09 FY 2009‐10 FY 2008‐09 FY 2009‐10
49 |
Priority Indicator: 7.4 – Consumer and Family Centered Care
Data Source: Consumer Perception Surveys
Sample Analyzed: Consumer Perception Survey Respondents To provide insight into consumer
and family perceptions of their received care, the receive data resulting from the FY 2008‐09 and
2009‐10 Consumer Perception Surveys were analyzed to create aggregate ratings of consumer and
family centered care. Among family members/caregivers and TAY respondents, ratings summarize
perceptions of: respectful treatment by staff, staff respect for religious/spiritual beliefs, good
communication with staff, staff sensitivity to cultural or ethnic background, and contribution to
choosing child’s services and treatment goals. Among adult and older adult respondents, ratings
summarize perceptions of: staff encouragement of recovery, freedom to raise complaints, receiving
information about rights, encouragement to take responsibility for lifestyle, information about
potential side effects of treatments, staff respect for confidentiality, staff sensitivity to cultural
background, provision of sufficient information to assume personal management of illness, and
encouragement to use consumer run programs. Five point response scales (i.e., 1 – Strongly
Disagree to 5 – Strongly Agree) were provided to respondents, thus ratings of 3.5 or greater
generally indicate positive perceptions of consumer/family centered care.
Figure 7.4 – 1. Perceptions of Consumer/Family Centered Care, FY 200809
Older Adult 4.25
Adult 4.21
TAY 4.07
Family Member/Caregiver 4.41
1 2 3 4 5
(See Appendix C, Table 7.4 ‐ 1 for response rates)
Figure 7.4 – 2. Perceptions of Consumer/Family Centered Care, FY 200910
Older Adult 4.01
Adult 3.87
Family Member/Caregiver 4.21
1 2 3 4 5
(See Appendix C, Table 7.4 ‐ 1 for response rates)
When compared to the subsequent year, ratings of consumer/family centered care were higher
among FY 2008‐09 respondents. However, differences between these fiscal years must be
interpreted with caution, as the convenience sampling method employed to gather FY 2008‐09 data
has been found to not be representative of the entire mental health service population.32
Additionally, the random sampling method employed during FY 2009‐10 is currently under
evaluation.
50 |
Within each fiscal year analyzed, family member/caregiver ratings were the most positive among
age groups (see Figure 7.4 ‐ 1).
Table 7.4 1. Perceptions of Consumer/Family Centered Care, by Race/Ethnicity
Family Member/
TAY Adult Older Adult
Caregiver
FY FY FY FY33 FY FY FY FY
2008 2009 2008 2009 2008 2009 2008 2009
2009 2010 2009 2010 2009 2010 2009 2010
4.46 4.23 4.13 4.23 3.80 4.27 3.99
White
(n=13,093) (n=568) (n=7,858) (n=20,149) (n=841) (n=2,374) (n=1,343)
Hispanic / 4.42 4.22 4.11 4.29 4.02 4.40 4.13
Latino (n=17,887) (n=492) (n=10,822) (n=11,376) (n=397) (n=894) (n=416)
4.41 4.12 4.06 4.19 4.01 4.27 3.99
Asian
(n=1,216) (n=57) (n=1,016) (n=3,126) (n=181) (n=332) (n=464)
Pacific 4.45 4.02 4.05 4.23 3.87 4.20 3.58
Islander (n=479) (n=23) (n=494) (n=1,748) (n=26) (n=40) (n=8)
4.40 4.17 4.03 4.25 3.87 4.26 4.00
Black
(n=6,141) (n=162) (n=4,525) (n=6,612) (n=201) (n=473) (n=159)
American 4.41 4.32 4.09 4.22 3.83 4.23 3.90
Indian (n=1,753) (n=70) (n=1,775) (n=2,626) (n=108) (n=185) (n=114)
Table 7.4 2. Perceptions of Consumer/Family Centered Care, by Gender
Family Member/
TAY Adult Older Adult
Caregiver
FY FY FY FY34 FY FY FY FY
2008 2009 2008 2009 2008 2009 2008 2009
2009 2010 2009 2010 2009 2010 2009 2010
4.40 4.18 4.15 4.29 3.91 4.32 4.05
Female
(n=13,123) (n=402) (n=10,290) (n=22,881) (n=932) (n=2,526) (n=1,587)
4.43 4.23 4.04 4.18 3.84 4.25 3.93
Male
(n=21,224) (n=656) (n=12,282) (n=18,450) (n=630) (n=1,575) (n=769)
Consumer/family‐centered care ratings were highest among Hispanic/Latino adults and older
adults during FY 2008‐09 and 2009‐10 (see Table 7.4 ‐ 1). Female respondents indicated higher
average ratings of consumer/family‐centered care than male consumers among TAY, adult, and
older adult respondents.
51 |
Priority Indicator: 7.5 – Integrated Service Delivery
Data Source: County Plans / Annual Updates
Counties/Municipalities Included: All
The Mental Health Services Act (MHSA) guidelines recognize that unaligned mental health services
provide barriers to access for mental health consumers. MHSA therefore promotes integrated care
that addresses all consumer needs at every stage of recovery. In order to establish integration,
service providers coordinate treatment from one service provider to the next.35 Integrated service
delivery implies that county mental health programs ensure that consumers transition smoothly
from intensive levels of care to outpatient care.
Integrated service processes are not tracked reliably statewide, thus county plans and annual
updates were systematically reviewed and coded to identify planned strategies and services. Most
counties (92%; 54) were found to detail plans for integrated service delivery. The following details
common integrated service delivery strategies reveled through this analysis.
Common Integrated Service Delivery Strategies
Counties detailed plans for a myriad of initiatives to foster integrated service delivery. These
actions include: referral to community contacts after referral or discharge, client movement in
response to need, stability of the client caregiver relationship, communication among providers,
and efforts to retrieve clients lost in the system.36 Figure 7.5 ‐ 1, highlights four key strategies for
achieving integrated service delivery and their intended outcomes.
Figure 7.5 1. Consumer and Family Centered Care definition, service strategies, and intended
outcomes37
Integrated Service Delivery:establishes continuity and plans
patient coordination from one service provider to the next in order
to treat the whole person at every stage of recovery.
Service Strategies:
1. Personal Service Coordinators/Case Managers provide linkages to needed services
2. Integrated Service Teams representing various social service agencies streamline services
3. Services are either co-located or situated within the community
4. Service providers coordinate with institutions such as law enforcement, probation, and the courts
Intended Outcomes:
• Patients more likely to attend outpatient appointments
• Decreased need for healthcare
• Increased communication between providers
• Reduced stigma against mental illness
• Reduced medical expenditures
• Increased combination of medical/psychiatric treatment
52 |
Nearly all (53) county CSS plans included brief statements regarding plans to provide “integrated
services”, although 71% (42) of county CSS plans provided more detailed descriptions of these
service strategies. Four key integrated service strategies found across counties (see Table 7.5‐1)
Table 7.5 – 1. Common Integrated Service Delivery Strategies
Counties/Municipalities Planning to Implement
Service Strategy
Strategy
Personal Service Coordinators/Case Managers
13 (22%)
provide linkages to needed services
Integrated Service Teams representing social service
35 (59%)
agencies streamline services
Services are either co‐located or situated within the
16 (27%)
community
Service providers coordinate with institutions such
21 (36%)
as law enforcement, probation, and the courts
Detailed descriptions of each service strategy are provided below:
1) Personal Service Coordinators/Case Managers provide linkages to needed services. 22%
of county plans (13) indicated that a specific mental
health employee will coordinate consumer transition Personal Service Coordinator/Case
Manager Statement from County CSS
from one service to the next. Plans indicate that these
Plan: “As Personal Service
staff members work one‐on‐one with the consumer
Coordinators/Case Managers, they will
and their individualized wellness plans; consumers
participate in delivering services and
therefore receive the services and supports most
coordinating care from the time a client
relevant to them. Furthermore, because the
enters the program, throughout the
individual staff member oversees the case from the service delivery program, and until
beginning, he or she is able to make sure the discharge. These individuals will provide
consumer does not become “lost in the system.” family support, supportive services,
linkage to services, rehabilitation
2) Integrated Service Teams representing social
services, and transportation.”
service agencies streamline services. 59% (35) of
county plans indicated that counties intend to coordinate service teams to streamline
transitions from one level of care to the next. For example, social services, mental health
services, inpatient facilities, and recovery centers collaborate to form one line of care. Plans
state that this will allow clients to experience a “seamless transition” from one service to the
next. Often, the variety and complexity of services prevents successful transition from one level
of care to the next; plans state that this streamlined system will provide direct service paths to
ensure that clients continue receiving a high quality of care.
3) Services are either colocated or situated within the community. 27% of county plans (16)
indicate that they intend to locate different services within the same facility or imbed services
in existing community locations. Therefore, as consumers transition to less intensive levels of
care, they would not need to seek out a
new service provider or location. County Colocated Services Statement from County CSS
plans indicate that co‐locating services or Plan: “Integrated physical and mental health
services, which includes colocation and/or
placing them in the community minimizes
collaboration with primary care clinics or other
the logistical issues consumers often face
health care sites and providers to provide
when trying to navigate the mental health
individualized, interdisciplinary, coordinated
system; consumers can easily move from
services. Linkage will be provided for children and
one service to the next without having to families served in these settings to the full range of
rearrange existing service patterns. mentalhealthserviceswhenneeded.”
53 |
Furthermore, when such services are situated in the community, CSS plans explain that
consumers will feel more comfortable accessing needed services, resulting in improved
coordination.
4) Service providers coordinate with institutions such as law enforcement, probation, and
the courts. 36% of county plans (21) indicate intentions to coordinate transition services with
public institutions. Often, mental health consumers begin receiving care in these institutions;
when such consumers transition out of their institutional placement, they need assistance with
coordinating service provision. As CSS Plans indicate, communicating with jails and other
institutions where the patient once resided allows service providers to transfer case histories;
new providers can therefore target service needs. Several county plans indicate that mental
health staff members would visit these public institutions before the consumer is released in
order to formulate a service plan. Such planning helps ensure that mental health consumers
successfully transition from one level of care to the next.
Analysis of county plans suggests that substantial variation in integrated service strategies exists
across counties. Such strategies set the stage for integrated service delivery models which are often
very detailed, as consumers’ paths through a streamlined system of care require coordination of
several agencies and services. Investigation of these strategies and service models may provide
insight into their effectiveness to support smooth consumer transitions to less intensive forms of
care.
54 |
Priority Indicator: 7.6 – Consumer Wellbeing
Data Source: Consumer Perception Surveys
Sample Analyzed: Consumer Perception Survey Respondents The concept of quality of life
encompasses many mental health and non‐mental health related consumer outcomes relevant to
the care of persons with serious mental illness. Quality of life has been defined as a broad concept,
representing a person’s sense of well‐being that stems from satisfaction or dissatisfaction with
areas of life that are important to her/him.38 Consumers see quality of life as the ability to achieve
what many others take for granted; this includes housing, social support, meaningful activities, and
an adequate standard of living.39
To provide insight into consumer and family perceptions, data regarding wellbeing as a result
services received, from the FY 2008‐09 and 2009‐10 Consumer Perception Surveys were analyzed
to create aggregate mean ratings. Among family members/caregivers and TAY respondents, ratings
of wellbeing as a result of services summarize perceptions of: the ability to handle daily life, good
relations with family members and friends, school or work performance, coping with setbacks, and
satisfaction with family. Among adult and older adult respondents, ratings of wellbeing as a result
of services summarize perceptions of: handling daily problems, control of one’s own life, ability to
deal with crisis, good relations with family members, ability to handle social situations, school or
work performance, meaningful activities, ability to take care of needs, coping with setbacks, ability
to do things one want to, contentment with friendships, having people to share activities with,
sense of community belonging, and support of family and friends. Five point response scales (i.e., 1
– Strongly Disagree to 5 – Strongly Agree) were provided to respondents, thus ratings of 3.5 or
greater generally indicate positive perceptions of wellbeing.
Figure 7.6 – 1. Perceptions of Wellbeing, FY 200809
Older Adult 3.92
Adult 3.84
TAY 3.85
Family Member/Caregiver 3.80
1.00 2.00 3.00 4.00 5.00
(See Appendix C, Table 7.6 ‐ 1 for response rates)
Figure 7.6 – 2. Perceptions of Wellbeing, FY 200910
Older Adult 3.73
Adult 3.50
Family Member/Caregiver 3.57
1 2 3 4 5
(See Appendix C, Table 7.6 ‐ 1 for response rates)
Overall, ratings indicate that on average, consumers and family members during FY 2008‐09 and
2009‐10 held positive perceptions of their wellbeing as a result of the services they received.
However, differences between these fiscal years must be interpreted with caution, as the
55 |
convenience sampling method employed to gather FY 2008‐09 data has been found to not be
representative of the entire mental health service population.40 Additionally, the random sampling
method employed during FY 2009‐10 is currently under evaluation.
Within each fiscal year analyzed, older adult ratings were more positive than any other age group
(see Figure 7.6 ‐ 1). Ratings of wellbeing were highest among Hispanic/Latino consumers, with the
exception of adults in FY 2009‐10 (see Table 7.6 ‐ 1). Males generally indicated higher average
ratings of wellbeing than female consumers during both fiscal years examined (see Table 7.6 ‐ 2).
Table 7.6 1. Perceptions of Wellbeing, by Race/Ethnicity
Family Member/
TAY Adult Older Adult
Caregiver
FY FY FY FY FY FY FY FY
2008 2009 2008 2009 2008 2009 2008 2009
2009 2010 2009 201041 2009 2010 2009 2010
3.73 3.52 3.85 3.84 3.41 3.91 3.70
White
(n=12,860) (n=562) (n=7,774) (n=20,021) (n=842) (n=2,330) (n=1,340)
Hispanic / 3.89 3.64 3.89 3.95 3.68 4.09 3.88
Latino (n=17,476) (n=494) (n=10,732) (n=11,362) (n=371) (n=871) (n=407)
3.86 3.50 3.81 3.90 3.69 3.99 3.74
Asian
(n=1,192) (n=57) (n=1,007) (n=3,138) (n=182) (n=322) (n=464)
Pacific 3.80 3.42 3.81 3.90 3.78 3.76 3.63
Islander (n=473) (n=23) (n=487) (n=1,757) (n=26) (n=41) (n=10)
3.69 3.56 3.85 3.86 3.51 3.96 3.73
Black
(n=6,043) (n=161) (n=4,476) (n=6,609) (n=202) (n=463) (n=158)
American 3.74 3.50 3.84 3.82 3.50 3.83 3.59
Indian (n=1,705) (n=70) (n=1,754) (n=2,645) (n=108) (n=181) (n=113)
Table 7.6 2. Perceptions of Wellbeing, by Gender
Family Member/
TAY Adult Older Adult
Caregiver
FY FY FY FY FY FY FY FY
2008 2009 2008 2009 2008 2009 2008 2009
2009 2010 2009 201042 2009 2010 2009 2010
3.80 3.54 3.82 3.85 3.50 3.95 3.74
Female
(n=12,865) (n=401) (n=10,173) (n=22,786) (n=936) (n=2,478) (n=1,575)
3.81 3.57 3.90 3.90 3.50 3.96 3.69
Male
(n=20,804) (n=652) (n=12,154) (n=18,426) (n=631) (n=1,534) (n=769)
56 |
Priority Indicator: 7.7 – Satisfaction
Data Source: Consumer Perception Surveys
Sample Analyzed: Consumer Perception Survey Respondents The perceptions of mental health
consumers and families are an important source of information regarding users’ experiences with
services, service providers, and service coordination. Positive relationships between satisfaction
ratings and treatment outcomes have been documented.43 Satisfaction is an indication of the extent
to which services and supports meet the needs of clients and families and is considered a key
dimension of service quality.
To provide insight into consumer and family satisfaction with services, data resulting from the FY
2008‐09 and 2009‐10 Consumer Perception Surveys were analyzed to create an aggregate of this
dimension. Among family members/caregivers and TAY respondents, ratings of satisfaction
summarize perceptions of: overall satisfaction with services, commitment of staff, the availability of
someone to speak with when troubled, appropriateness of services, receipt of help wanted, and
receipt of sufficient help. Among adult and older adult respondents, ratings of satisfaction
summarize perceptions of: positive appraisal of services, preference for service agency when other
options exist, and willingness to recommend services to others. Five‐point response scales (i.e.,
Strongly Disagree – Strongly Agree) were provided to respondents, thus ratings of 3.5 or greater
generally indicate positive perceptions of consumer/family‐centered care.
Figure 7.7 – 1. Satisfaction with Services, FY 200809
Older Adult 4.43
Adult 4.33
TAY 4.05
Family Member/Caregiver 4.31
1 2 3 4 5
(See Appendix C, Table 7.7 – 1 for response rates)
Figure 7.7 – 2. Satisfaction with Services, FY 200910
Older Adult 4.16
Adult 3.95
Family Member/Caregiver 3.89
1 2 3 4 5
(See Appendix C, Table 7.7 – 1 for response rates)
Average ratings of satisfaction remained in the positive range in both fiscal years, indicating general
satisfaction with services. Differences between these fiscal years must be interpreted with caution,
as the convenience sampling method employed to gather FY 2008‐09 data has been found to not be
representative of the entire mental health service population.44 Additionally, the random sampling
method employed during FY 2009‐10 is currently under evaluation.
57 |
Within each fiscal year analyzed, older adult ratings were more positive than any other age group
(see Figure 7.7 ‐ 1).
Table 7.7 1. Satisfaction with Services, be Race/Ethnicity
Family Member/
TAY Adult Older Adult
Caregiver
FY FY FY FY FY FY FY FY
2008‐ 2009‐ 2008‐ 2009‐ 2008‐ 2009‐ 2008‐ 2009‐
2009 2010 2009 201045 2009 2010 2009 2010
4.31 3.87 4.10 4.35 3.84 4.47 4.13
White
(n=13,069) (n=568) (n=7,858) (n=20,155) (n=838) (n=2,375) (n=1,347)
Hispanic / 4.35 3.93 4.09 4.42 4.07 4.57 4.33
Latino (n=17,821) (n=495) (n=10,812) (n=11,388) (n=368) (n=892) (n=415)
4.31 3.86 4.02 4.32 4.12 4.42 4.15
Asian
(n=1,214) (n=57) (n=1,015) (n=3,131) (n=180) (n=332) (n=459)
Pacific 4.33 3.68 4.04 4.38 3.82 4.15 3.60
Islander (n=478) (n=23) (n=495) (n=1,753) (n=26) (n=41) (n=8)
4.28 3.87 4.02 4.35 4.03 4.37 4.15
Black
(n=6,124) (n=162) (n=4,521) (n=6,618) (n=203) (n=472) (n=159)
American 4.27 4.00 4.06 4.30 3.80 4.44 4.10
Indian (n=1,746) (n=70) (n=1,772) (n=2,626) (n=109) (n=184) (n=114)
‐‐ ‐‐ ‐‐ ‐‐ ‐‐ ‐‐ ‐‐
Unknown
(n=5,109) (n=102) (n=5,012) (n=11,262) (n=230) (n=1,240) (n=420)
Satisfaction ratings varied substantially across racial/ethnic groups (see Table 7.7 ‐ 1). As
compared to males, female consumers indicated greater satisfaction with services across most age
groups and both fiscal years examined (see Table 7.7 ‐2).
Table 7.7 2. Satisfaction with Services, by Gender
Family Member/
TAY Adult Older Adult
Caregiver
FY FY FY FY FY FY FY FY
2008‐ 2009‐ 2008‐ 2009‐ 2008‐ 2009‐ 2008‐ 2009‐
2009 2010 2009 201046 2009 2010 2009 2010
4.31 3.87 4.13 4.41 4.01 4.49 4.22
Female
(n=13,082) (n=404) (n=10,279) (n=22,891) (n=931) (n=2,527) (n=1,583)
4.32 3.90 4.02 4.32 3.85 4.42 4.04
Male
(n=21,176) (n=655) (n=12,281) (n=18,457) (n=628) (n=1,571) (n=768)
Overall ratings indicate that on average, consumers and family members during FY 2008‐09 and
2009‐10 were generally satisfied with the services they received; this provides a positive indication
of service quality.
58 |
Domain: Structure
Priority Indicator: 8.1 – Evidence Based or Promising Practices and
Programs
Data Source: County Plans / Annual Updates
Counties/Municipalities Included: All
Evidence Based Practice (EBP) refers to a body of scientific knowledge about service practice;
specifically, the term indicates the quality, robustness, or validity of scientific evidence as it is
examined in the clinical setting.47 In other words, EBPs are interventions that have been found to
consistently improve client outcomes.48 The use of such established practices is considered an
indicator of appropriate and competent care.
Historically, California has not rated highly on evidence based practice implementation across the
mental health system, in reports to SAMHSA. MHSA‐supported implementation of evidence based
or promising practices is not tracked reliably statewide. To provide indication of the prevalence of
EBPs or promising practices planned, county plans and annual updates were initially reviewed and
coded to assess the variety of services. Services found were identified as evidence based by a panel
of experts, county representatives, and other stakeholders. Then county plans were coded to assess
the frequency of plans to implement evidence based practices. Figure 8.1 ‐ 1 highlights EBPs and
the prevalence with which they were planned to be implemented statewide.
Figure 8.1 1. Evidence Based Practices Planned
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
WellnessRecoveryActionPlan(41) 69%
CognitiveBehavioralTherapy(16) 27%
Dialectical BehaviorTherapy(4) 7%
SocialSkillsTraining(21) 36%
BehaviorTherapy(10) 17%
Modeling(6) 10%
FamilyPsychoeducation(20) 34%
PartnersinCare(1) 2%
PsychoeducationalMulti‐FamilyGroups(3) 5%
IMPACT (Improving Mood ‐ Promoting Access to… 2%
MultisystemicTherapy(3) 5%
TherapeuticFosterCare(4) 7%
Parent‐ChildInteractionTherapy(13) 22%
Wraparound(40) 68%
59 |
The most common EBPs planned across the state include “Wraparound” services and “Wellness
Recovery Action Plans.” These approaches have the common thread of tailored or individualized
treatment to achieve wellness goals. The prevalence with which these EBPs were planned across
the state reflects the emphasis on client centered care throughout the mental health care system.
To familiarize the reader with the EBPs planned across the state, the proceeding section details
each approach.
Evidence Based Practices – Detail
Wellness Recovery Action Plan (WRAP): Allows mental health consumers to recognize their
personal assets in order to create an individualized action plan tailored towards the consumers’
goals; the WRAP model facilitates mental health consumers in directing their own path to
wellness.49
Cognitive Behavioral Therapy: Focuses on treating a consumer’s negative thought patterns and
attempts to uncover the beliefs that promote such thinking; this reflective process aids in reversing
maladaptive thinking patterns.50
Dialectical Behavior Therapy: Modification of Cognitive Behavioral Therapy designed to specifically
treat individuals with self‐harm behaviors; clients receive individual therapy, skills group, and
phone coaching.51
Social Skills Training: Teaches mental health consumers about the verbal and nonverbal behaviors
in social interactions in order to help consumers relate to other individuals.52
Behavior Therapy: Increases the mental health consumer’s engagement in positive activities in
order to help the individual comprehend how changing their behavior can change how they are
feeling.53
Modeling: Mental health consumers observe individuals coping in situations that typically cause
them anxiety; the underlying principle is that people can change through watching others
successfully managing problems typically faced by the client.54
Family Psychoeducation: Consumers and their families engage in psychoeducation therapy for at
least six months; therapy focuses on education about the illness, problem solving, creating social
supports, and developing coping skills.55
Partners in Care: Attempts to improve the quality of mental health care through collaboration
between specialist and generalist, active case management, and patient empowerment.56
Psychoeducational Multifamily Groups: Similar to Family Psychoeducation, however this approach
involves consumers and their families meeting with five to six additional families in one setting.57
IMPACT (Improving Mood‐‐Promoting Access to Collaborative Treatment): Depression treatment
for older adults using a collaborative and stepped care approach in primary care.58
Multisystemic Therapy: Improves outcomes for chronic and violent juvenile offenders through
implementing an intensive community and family based treatment program in which clinicians are
available “24/7”.59
Therapeutic Foster Care: Places foster care children with families who have been specially trained
to care for youth with specific medical or behavioral needs.60
Parent‐Child Interaction Therapy: Assists youth with emotional and behavioral disorders through
focusing on changing the behavior of both the parent and the child by restructuring interaction
patterns.61
60 |
Wraparound: A community based empowerment approach designed for families of children and
adolescents with emotional and behavioral disorders; treatment provides an individualized
strengths and resiliency counseling for one to two years.62
61 |
Priority Indicator: 8.2 – Cultural Appropriateness of Services
Data Source: Workforce Education and Training (WET) Plans; County Plans / Annual
Updates
Counties/Municipalities Included: All
Disparities exist amongst racial and ethnic minorities regarding access and utilization of mental
health services.63 To mitigate this issue, researchers suggest that practitioners adapt their services
to meet the cultural and linguistic needs of their client demographic. Often, this type of provision is
referred to as “cultural competency.” Cultural competence refers to a set of skills or processes that
allow mental health practitioners to provide services in the most appropriate way for the diverse
populations they serve.64 This approach includes attention to language differences and how culture
affects attitudes, expressions of distress, and help seeking practices. Culturally competent services
and professionals demonstrate respect for consumers’ cultural context and are willing to learn
about other cultures.65 Implementing culturally competent practices can help break down barriers
that underserved or un‐served individuals often face when seeking treatment.
Culturally competent services are not tracked reliably statewide, thus county plans and annual
updates were systematically reviewed and coded to identify culturally appropriate strategies and
services. All California Counties detailed plans to implement culturally competent services, most in
line with the recommendations of the California Mental Health Master Plan. Further investigation
into each culturally competent service strategy planned, and their prevalence across the state, was
conducted. The proceeding narrative highlights the specific California Mental Health Master Plan
recommendations and the percent of counties planning to utilize such strategies.
Prevalence of Culturally Competent Service Strategies
Counties/Municipalities
Service Strategy
Planning to Implement Strategy
“Health care organizations should implement strategies to recruit,
retain, and promote at all levels of the organization, a diverse staff and
40 (68%)
leadership that are representatives of the demographic characteristics
of the service area”
“Health care organizations must offer and provide language assistance
52 (88%)
services, including bilingual staff and interpreter services”
“Health care organizations must make available easily understood
patient‐related materials and post signage in the languages of the
24 (41%)
commonly encountered group and/or groups represented in the service
area”
“Health care organizations should develop participatory, collaborative
partnerships with communities and utilize a variety of formal and
44 (75%)
informal mechanisms to facilitate community and patient/consumer
involvement”
“California should improve access to treatment by providing high
quality, culturally responsive, and language‐appropriate mental health
52 (88%)
services in locations accessible to racial, ethnic, and cultural
populations”
Culturally competent service strategies are detailed below:
“Health care organizations should implement strategies to recruit, retain, and promote at all
levels of the organization, a diverse staff and leadership that are representatives of the
62 |
demographic characteristics of the service area.” 68% (40) of counties plan to provide
culturally competent services through recruiting, retaining, and promoting staff that are
representative of the population served. This strategy helps ensure that consumers receive care
from individuals who are knowledgeable and aware of their specific ethnic, cultural, and linguistic
background.
“Health care organizations must offer and provide language assistance services, including
bilingual staff and interpreter services.” 88% (52) of counties plan to provide linguistically
appropriate services through bilingual staff and/or interpreter services. Counties have recognized
where language gaps exists and indicate plans to target
Culturally Appropriate Materials
those specific threshold languages in order to provide
Example from County CSS Plan:
culturally appropriate services.
“[County] will employ culturally
“Health care organizations must make available competent community visibility by
easily understood patientrelated materials and post making use of “homegrown” media,
signage in the languages of the commonly such as radio stations and publications
that promote wellness and resiliency at
encountered group and/or groups represented in the
the local level”
service area.” 41% (24) of counties plan to create and
disseminate patient‐related materials reflective of the culture and language in a particular service
area. Several counties stated that this would be done through upgrading signage at facilities and
providing culturally specific décor. Other plans described culturally and linguistically relevant
materials used for outreach and education.
Culturally Appropriate Materials Example from County CSS Plan:“[County] made a major commitment
to adapting facilities to the diverse cultural backgrounds of county residents to assure their comfort as they
access mental health services. Over the course of two years nearly ten thousand dollars was spent on the
acquisition of multicultural art to be placed in all consumer lobbies.”
“Health care organizations should develop participatory, collaborative partnerships with
communities and utilize a variety of formal and
informal mechanisms to facilitate community and Community Partnership Example from
County CSS Plan: “Community cultural
patient/consumer involvement.” 75% (44) of
practices – traditional practitioners, natural
county CSS plans indicate that they plan to partner
healing practices and ceremonies recognized
with communities to incorporate the natural supports
by communities in place of or in addition to
and culture of a particular service population. For
mainstream services.”
example, several communities planned to partner
with tribal organizations and ethnicity specific organizations to assist in the wellness and recovery
of consumers.
“California should improve access to treatment by providing high quality, culturally
responsive, and languageappropriate mental health services in locations accessible to
racial, ethnic, and cultural populations.” 88% (52) of counties plan to implement mental health
care services in the community, and 81% (48) specified where services will occur. The following
locations include those targeted for community based service provision:
63 |
• Consumer homes • Homeless Shelters
• Schools (Preschool, Elementary, • Foster Homes
Middle and High Schools)
• Jails and Juvenile Halls
• Neighborhood Community
• Primary Care Clinics
Organizations
• Migrant Labor Camps
• Adult Residential Facilities
• Assisted Living Centers
• Congregate Housing Centers
• Faith‐Based Providers
Providing services in these community settings is intended to allow consumers to feel comfortable;
services provided in a culturally or socially familiar context is more meaningful to the consumer.
64 |
Priority Indicator: 8.3 – Recovery, Wellness, and Resilience Orientation
Data Source: Workforce Education and Training (WET) Plans; County Plans / Annual
Updates
Counties/Municipalities Included: All
MHSA guidelines recognize and support the emerging statewide “recovery, wellness, and resiliency
orientation” approach.66 The recovery, wellness, and resilience perspective acknowledges that all
individuals can recover from mental illness; this includes individuals experiencing extreme
difficulties over a long period of time. Mental health consumers and practitioners with a recovery,
wellness, and resiliency orientation do not believe that individuals with mental illness will continue
to deteriorate. Rather, they encourage mental health improvement in non‐sequential, dynamic
stages. These stages embrace the concepts of hope, empowerment, self‐responsibility, and a
meaningful role or “niche” in life.67
The CA Wellness Recovery Task Force outlines the following as cornerstones of a recovery‐oriented
system:
• A widespread understanding of, and belief in, recovery among staff, consumers and family
members
• Quality of life program elements that lead to the creation of integrated services
• Quality of life outcome data incorporated into program design monitoring
• Consumers and family members widely employed throughout mental health administration and
programs in a variety of roles.
• Leadership promotion of recovery‐oriented principles and practices
• Staff training focused on recovery‐oriented values, principles and practices
• Partner with community resources to maximize access
• Reduction in the use of hospitals and institutional settings (if not the elimination)
• People who are homeless, institutionalized, and those in transition from the children's system
of care to adulthood are effectively engaged and supported
• Consumers and families involved in all aspects of system planning and management68
To provide a greater understanding of how counties intend to promote a wellness, recovery and
resilience orientation, county plans and annual updates were systematically reviewed and coded to
identify relevant strategies and services. The prevalence of strategies and services intended to
promote a wellness, recovery and resilience orientation are detailed in the following sections.
Collaboration with Community Services
According to the California Wellness Recovery Task Force a recovery‐oriented mental health
system “partners with community resources to maximize access.” A review of county CSS Plans
illustrates that 96% (57) of counties plan to collaborate with community resources. Most counties
(86%; 51) provided detailed collaboration descriptions. These plans align with recommendations
outlined in the California Mental Health Master Plan: A Vision for California. These recommendations
outline two forms of community collaboration. The quotation below illustrates the specific
recommendation.
65 |
“Partnership development will focus on two separate groups—service providers and
other community groups that have access to children and families. Relationships with
these groups will help to expand referral and training opportunities.”
Interagency collaboration represents the first recommendation, such that: “The county mental
health departments should actively facilitate the interagency collaboration among social services,
health, and mental health agencies to serve racial, ethnic, and cultural populations more
effectively.” 83% (49) of counties plan to coordinate mental health services with related agencies in
the community. For example, several plans illustrate intentions to collaborate with county
departments and social service agencies.
The second recommendation pertains to
“ecologically valid services.” According to the Example of Ecologically Valid Services from
County CSS Plan: “[Services] will not only help
Master Plan: “Ecologically valid services enhance
the individuals/families identify these strengths
access by being provided in churches, housing
but will also try to identify and collaborate with
projects, and other community facilities used by
any spiritual or religious leaders, natural
racial, ethnic, and cultural communities.” Another
support systems, community organizations and
recommendation states that “The DMH should selfhelp groups that could be beneficial to the
encourage county mental health departments and recovery process for an individual/family”
the agencies with which they contract to structure
services so clients can use natural support systems in their own racial, ethnic, and cultural
communities,”. 68% of counties plan to implement ecologically valid services. For many counties,
this service provision entails partnering with organizations that consumers already utilize as
support systems.
Substance Abuse Treatment
The second California Wellness Recovery Task Force cornerstone states that recovery oriented care
includes: “Quality of life program elements that lead to the creation of integrated services.”
Therefore, staffing substance abuse specialists helps promote recovery, resilience, and wellness.
The following figures display the percentage of counties planning to include substance abuse
specialists on staff. A review of all county CSS Plans reveals that 78% (46) of counties plan to
include substance abuse specialist as part of the mental health staff.
Discharge Planning
The California Wellness Recovery Task Force states that a recovery‐oriented system includes:
“People who are homeless, institutionalized, and those in transition from the children's system of
care to adulthood are effectively engaged and supported.” The California Mental Health Master Plan:
A Vision for California further details what this transition implies. One aspect requires mental health
providers to “specify discharge readiness criteria, i.e., when services will no longer be necessary.”
Once practitioners determine consumer readiness, the practitioner must create a plan for the
consumer’s discharge. The specific recommendation states “All counties should establish an
Interagency Policy Council…the duties of this council would be to coordinate discharge planning,
provide consistent treatment of clients in jails, and implement and expand diversion programs.” In
addition to incarcerated consumers, discharge planning should include individuals in inpatient and
acute facilities.
County CSS plans indicate that 30% (18) of counties plan on implementing discharge planning
and/or creating discharge criteria. Fifteen percent (9) of counties detailed the services they
intended to provide.
66 |
Developing specific discharge criteria represents the first dimension of discharge planning. The
California Mental Health Master Plan: A Vision for California indicates that these criteria are part of
each consumer’s individualized plan; these criteria are therefore specific to the individual’s needs
and abilities to transition out of service provision. Plans also state that this plan is frequently used
to help children and adolescents transition to out of state services such as foster care and group
homes.
Creating a discharge plan for persons
incarcerated, residing in inpatient facilities, Example of Discharge Planning from Count y CSS
or acute care is the second aspect to Plans: “One full time staff will be located at the Main
Jail and will focus on discharge planning to ensure a
discharge planning. CSS Plans detail that this
seamless transition into a community facility.”
planning requires coordination with various
agencies in order to ensure a proper
transition that prevents consumers from becoming “lost in the system.” Plans also explain that
Personal Service Coordinators or Multidisciplinary Teams will be responsible for this discharge
planning; these individuals will attend discharge meetings and craft individualized plans based on
the consumers’ needs.
Workforce Education and Training for a Recovery, Wellness and Resilience
Orientation
County Workforce Education and Training (WET) Plans indicate which programs promote
recovery, resiliency, and wellness. According to totals compiled from each county WET Plan Action
Matrix, 98% (406) of all actions planned across all counties promote recovery, resiliency, and
wellness.
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Discussion: ConsumerLevel Priority Indicators
Consumer‐level priority indicators were designed to assess consumers’ dispositions over time,
including those sponsored by the MHSA. The indicator set should measure both mental health and
cues of mental health service impact on consumers. The utility of each indicator is briefly discussed
by priority indicator.
Domain: Education and Employment
Education – FY 2009‐10 data was not analyzable for comparison; it remains to be seen if an
anticipated decrease across the proportion of children decreased from year to year. Data proposed
for this indicator – how often children and TAY attend school – is not currently collected, thus an
estimate of attendance was calculated using suspensions and expulsions. This misses the mark on
measuring daily absences and should be addressed through data collection or indicator refinement
for future reports.
Employment – DCR data provided robust information with which to calculate paid and non‐paid
employment rates across FY 2008‐09 and 2009‐10. Data revealed that of the small percentages of
FSP consumers who were employed, most received pay for their work. Nearly all CSI employed
consumers received pay. The variables used provide information regarding the proportion of
employed consumers at any given point in the fiscal years; however do not provide a sense of how
long consumers held a particular employment status. A close examination of the data indicated that
consumers, who are surveyed multiple times during each fiscal year, maintained their employment
statuses for much of the year.
Domain: Homelessness and Housing
There are some outstanding questions regarding the accuracy and reliability of the data in
reflecting the status of housing for consumers. The data used in determining housing status were
collected sporadically. For FSP consumers, these data were collected through Key Event Tracking
(KET); for CSI consumers, through periodic updates. However, feedback from counties suggests
that a uniform standard does not exist for such updates. This reduces confidence that these data
faithfully and completely capture a description of a status so transitory as homelessness. In
particular, it would be reasonable to expect that those consumers at highest risk would also be least
likely to be represented in such periodic updates. There are, then, two issues that need further
study before making substantive claims based on these data: (1) the standard practices for
meriting and recording such periodic updates; and (2) the efficacy of these practices in faithfully
and completely representing the consumer population.
Domain: Justice Involvement
Arrests – The evaluation team attempted to calculate both arrests and incarcerations to examine
consumers’ involvement with the justice system during FY 2008‐09 and 2009‐10. Consumer
perception surveys provided scant information (and none about youth arrests). However, DCR data
revealed more robust findings – the arrest rate was <1 per FSP consumer. Other variables are
available in the data to more closely examine post‐arrest activities such as detention, incarceration,
probation camp and the like. Subsequent reports would be improved with the addition of this
information once it has been reviewed by counties.
Incarcerations Stakeholders proposed incarceration counts to gain more insight about the state
of consumers’ justice involvement. While there are variables that are similar to incarceration, none
directly measure this in both CSI and DCR datasets in ways that can be easily extracted for analysis,
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which creates a challenge for the evaluation. A review of the legal class categories might yield a new
field such that incarcerations can be accounted for in subsequent evaluations.
Domain: Emergency Care
Emergency Intervention for Mental Health Episodes – Calculations using CSI data showed that
on average consumers visited hospitals for mental health episodes less than once annually. Such
visits were rare across the target fiscal years. In contrast, consumers often visited non‐hospital
facilities for emergency care. Consumers visited such facilities between four and six times annually,
suggesting that urgent care is addressed largely by these facilities. Findings are limited by the lack
of comparable DCR data to reveal where FSP consumers receive their emergency care. The
evaluation team seeks such information in the services of understanding how FSP consumers are
similar or dissimilar in the ways that they address their emergency care needs.
Emergency Intervention for Cooccurring Physical Injury – No data is currently available to
create an appropriate measure of co‐occurring physical injury. Medical notes that could clearly
identify such injuries for extraction and quantification have not yet been identified. A systematic
way of collecting such information through CSI or DCR is recommended for the purpose of
capturing how many visits consumers make to any urgent care facility for injuries that are related
to or caused by mental health instability.
Domain: Social Connections
Social Connection – Stakeholders suggested social connections as an additional indicator domain
to measure well being. The indicator is a strong addition to consumer‐level measurement, however
data is not readily available to count how many family members, non‐family members, and
organizations consumers deem “supportive” during a crisis and everyday life.
Discussion: Mental Health System Performance Indicators
This report represents an important step toward refining priority performance indicators of the
mental health system. System level priority indicators were designed to provide a multidimensional
understanding of how the mental health system overall, and MHSA supported programs
specifically, are serving consumers and their families, providers, and other stakeholders.
Conclusions and implications regarding the reliability, diagnostic utility and sustainability of
system level priority indicators, which can be drawn from the analyses of existing data presented in
this report, are discussed below.
Domain: Access
Demographic Profile of Consumers Served – Services to minority consumers increased year‐to‐
year as a proportion of the overall service population. Results provide better understanding of the
extent to which county mental health systems are serving minority and other traditionally
underserved or unserved populations. However, the snapshot of mental health service populations
provided by this indicator must be viewed with an understanding of the brief time span
investigated (FY 2008‐09 and 2009‐10), as well as inconsistencies of mental health service
information (e.g., year‐to‐year and between counties) expressed by several counties and
stakeholders, and supported data quality analysis. This indicator can provide important
understanding of mental health service populations and their changing composition. Further
analysis of service information from additional years will provide greater insight concerning
changes in minority participation in the mental health system and what drives it.
69 |
New Consumers – The proportion of all new mental health consumers increased and the
proportion of new FSP consumers decreased year‐to‐year. Older adult, adult, and TAY consumers
increased as a proportion of all new mental health consumers, while TAY and children increased as
a proportion of FSP consumers served between FY 2008‐09 and 2009‐10. Understanding who new
mental health consumers are can provide indication of changes in the composition of service
populations. This indicator will provide greater understanding as analysis of information from
additional service years is conducted.
Penetration of Mental Health Services – A moderate proportional decrease in penetration rates
year‐to‐year was found, however this trend should be considered in the context of increasing
service need and decreasing county resources, since the 2008 economic downturn. Indications of
the extent to which mental health services are reaching those in need are a crucial component of a
multidimensional assessment of the mental health system. As the accuracy of estimations of the
need for mental health services improves, the rate of penetration of mental health services will
become more reliable and instructive.
Access to a Primary Care Physician – Many mental health consumers view primary care as a
cornerstone to their healthcare and therefore look towards general practitioners to assist with their
mental health service provision.69 Trends suggest that FSP consumers’ access to a primary care
physician is increasing. This indicator provides insight into the extent to which consumers are
connected with a key point of access to mental health service. More complete and regular tracking
of this factor among FSP consumers, and initiating tracking of this factor among all mental health
consumer, would increase the diagnostic value of this indicator.
Perceptions of Access – Ratings suggest that on average consumers held positive perceptions of
their access to mental health services. As noted earlier, concerns regarding the sampling methods
utilized to collect consumer perception information reduce confidence in the representative nature
of this data, and do not allow for reliable comparisons across time. Implementation of a sampling
methodology, which can produce information that is representative of consumer perceptions
statewide and in each county, will improve the accuracy and utility of this indicator.
Domain: Performance
FSP Consumers Served – The ratios of FSP consumers served to planned service targets improved
year‐to‐year. This trend is attributable to increased service rates and more accurate service targets
established by counties as programs become more established. This indicator provides insight into
the extent to which service levels are in line with service projections of counties. As county service
projections become more precise and additional years of data are available, the accuracy of this
indicator and utility for monitoring service patterns will improve.
Involuntary Status – Involuntary status rate patterns largely reflected the path mental health
consumers take through the involuntary services system. Investigations of involuntary status
patterns over time are necessary to provide a fuller picture of their use. This indicator has the
potential to provide monitoring of intense services, which require substantial resources.
24Hour Care – Overall, FSP consumers received 24‐hours services at greater rates, compared to all
mental health consumers, during FY 2008‐09 and 2009‐10. This is likely attributable to FSP
eligibility criteria and the resources of CSS programs to provide such intensive services. However, a
larger proportion of adult mental health consumers overall received 24‐hour care, relative to adult
FSP consumers, which may be indicative of FSP emphasis on consumer progress toward less
intensive forms of care. This indicator can provide monitoring of the success of the mental health
system in transitioning consumers to less intensive forms of care.
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Consumer and Family Centered Care – Average ratings indicate consumers held positive
perceptions of consumer and family centered care. A variety of consumer/family centered care
strategies were planned across counties, with common emphasis on placing the needs and
empowerment of consumers at the center of the service process. Considering these assessments
together, this indicator can provide insight into the service approaches which support a consumer
and family oriented care.
Integrated Service Delivery – Mental Health Services Act (MHSA) guidelines recognize that
unaligned mental health services create barriers to care for mental health consumers. Analysis of
county plans suggests substantial variation in integrated service strategies across counties. Such
strategies set the stage for integrated service delivery models, which are often very detailed, as
consumers’ paths through a streamlined system of care require coordination of several agencies
and services. Further investigation of these strategies and routine tracking of the processes
involved are necessary to create a more comprehensive indicator of successful integration of
service delivery, which can support smooth consumer transitions to less intensive forms of care.
Consumer Wellbeing – Ratings indicate on average consumers and family members during FY
2008‐09 and 2009‐10 held positive perceptions of their wellbeing as a result of the services they
received. These perceptions provide another indication of the quality and appropriateness of care
consumers receive.
Satisfaction – Ratings suggest that on average consumers and family members during FY 2008‐09
and 2009‐10 were generally satisfied with the services they received. This indicator provides
another consumer driven assessment of service quality.
Domain: Structure
Evidence Based Practices – The most common EBPs found among county plans include
“Wraparound” services and “Wellness Recovery Action Plans.” These approaches have the common
thread of tailored or individualized treatment to achieve wellness goals. The prevalence with which
these EBPs were planned across the state reflects the emphasis on client centered care among
MHSA supported programs. While this indicator does provide insight into the diversity and
prevalence of planned evidence‐based services, routine tracking of such services will be necessary
to create an indicator which can reliably monitor patterns of EBP use over time.
Cultural Appropriateness of Services – Studies indicate that mental health interventions targeted
at a specific cultural group are more effective than interventions aimed to serve a diverse cultural
group. Furthermore, interventions conducted in the client’s native language are twice as effective as
interventions conducted in English. As such the most commonly planned strategies to provide
culturally appropriate services across the state are intended to address service disparities among
MHSA programs. However, routine tracking of processes intended to promote culturally
appropriate service will be necessary to create an indicator, which can reliably monitor the use and
effectiveness of these efforts.
Recovery, Wellness, and Resiliency Orientation – MHSA values support the emerging statewide
“recovery, wellness, and resiliency orientation” approach. The variety and comprehensiveness of
planned strategies intended to promote this approach (e.g., Collaboration with Community Services,
Substance Abuse Treatment, and Discharge Planning, and Workforce Education and Training)
demonstrate a strong base has been provided to support the expansion of this orientation.
However, routine tracking of processes intended to promote a recovery, wellness, and resiliency
orientation will be necessary to create an indicator, which can reliably monitor the use and
effectiveness of these efforts.
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System Indicator Summary
The system level priority indicators presented in this report provide a multidimensional
assessment of access, performance qualities, and the structure and orientation of the MHSA
programs and the mental health service system more broadly. Analyses presented provide greater
understanding of the reliability, diagnostic utility and sustainability of system level priority
indicators, in light of existing data system and sources. Many system‐level indicators were found
hold explanatory potential regarding the progress the community mental health system. Other
indicators were found to require additional development or supporting information. As such, this
report represents an important intermediate step, necessary to arrive at a more focused, reliable,
and instructive mental health performance monitoring system.
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Next Steps for the Evaluation
The following figure outlines next steps for the evaluation (additional detail is provided below):
Initial State Level Priority Indicator Report for
Stakeholder Input
•The present report highlighted initial analysis of priority
indicators, developed by the California Mental Health Planning
Council, stakeholders, experts, and the evaluation team. and
approved by the MHSOAC .
Stakeholder Feedback Process (through August 28,
2012)
•The current report and a feedback guidance document will be widely
disseminated , and posted at
http://www.mhsoac.ca.gov/Announcements/announcements.aspx
•Webinars will be held, which summarize this report and detail the
stakeholder feedback process
Final State Level Priority Indicator Report Including
Stakeholder Feedback
•The current report will be revised to incorporate feedback from
stakeholders
•A revised report will present analysis of indicator data from all
counties, regardless of response to Data Quality Assurance Reports
•A revised report is due to the MHSOAC on September 30th2012
Initial County Level Priority Indicator Reports
•Reports will be developed for each California county and municipality
administering MHSA programs, which include analysis of a refined set
of priority indicators for county level performance monitoring
•These reports will be designed to provide each county and
municipality with an in depth look at priority indicators of consumer
outcomes and community mental health system perforamnce
•Initial County reports are due to the MHSOAC on September 30th2012
State & County Level Priority Indicator Reports (2nd
edition)
•Reports will be produced at the state and county levels, which present
analysis of the most recent data available, and revised priority
indicators based upon stakeholder feedback and lessons learned from
initial priority indicator analysis
•The 2nd editions of state and county level reports are due to the
MHSOAC on March 31st, 2013
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Additional detail follows, regarding the stakeholder feedback process, which will guide revision and
development of this report, as well as upcoming reports:
Stakeholder Engagement and Feedback
Stakeholder feedback throughout the evaluation process has been integral to shaping this and other
documents about priority indicator development. The evaluation team incorporates stakeholder
feedback – a continual process – in generating all statewide and county‐specific reports.
In the evaluation’s earliest stages, input was collected from stakeholders through email
correspondence and webinar discussions.3 Through a series of conference calls, data stakeholders
(senior analysts from the California Department of Mental Health) provided about and access to the
project’s target databases (e.g., CSI and DCR). Other critical participants in the feedback process
included county representatives who were responsible for their local data. They verified data
accuracy through quality assurance reports. Their responses were requisite in creating a more
meaningful array of indicators from which the MHSOAC will select a final set to measure MHSA
impact.
In continuing this valuable process, the evaluation team invites readers’ responses to the current
document. The UCLA‐EMT evaluation team welcomes general comments and responses to the
accompanying guidance document found at:
http://www.mhsoac.ca.gov/Announcements/announcements.aspx.70
The feedback period will close on Tuesday, August 28, 2012. Following the close of the feedback
period, the evaluation team will incorporate, where possible, or note feedback in a revised, final
report. In addition, subsequent to the release of this report, webinars will be held for all interested
stakeholders. Webinars will include introduction to this report and details regarding the
stakeholder feedback process. A schedule of upcoming webinars will be publically disseminated
and posted at:
http://www.mhsoac.ca.gov/Announcements/announcements.aspx.71
This dissemination and feedback process will provide an opportunity for a spectrum of
stakeholders, as well as experts in the field, to contribute to the refinement of priority indicators
and initial examination of MHSA impact on specific populations (e.g., age groups, race/ethnicity,
and economic/living situation).
Upcoming Reports
Mental Health Services Act Evaluation: Initial Statewide Priority Indicator Report (including
stakeholder input)
Following the close of the feedback period (ending Tuesday, August 28th), the evaluation team will
incorporate, where possible, or note feedback in a revised version of the present report. The
revised report, to be delivered on September 30th 2012, will present analysis of indicator data from
all counties, regardless of response to Data Quality Assurance Reports. The report will also
3 Members of the California Mental Health Directors Association (CMHDA) Indicators, Data, Evaluation and
Accountability (IDEA) Ad‐Hoc Committee and MHSA stakeholders provided input as a part of webinar
discussions. In addition, the evaluation team extended an electronic call for feedback through approximately
30 mental health organizations and agencies of various clientele, size, focus, and reach throughout the state
(refer to Appendix A of Mental Health Services Act Evaluation: Compiling Data to Produce All Priority
Indicators; November 2, 2011).
74 |
emphasize the vital role of stakeholders in the development and revision process, so as to ensure
the most appropriate and accurate refinement of the priority indicators of the community mental
health system.
Mental Health Services Act Evaluation: Initial County Priority Indicator Reports
The UCLA‐EMT MHSA evaluation team will prepare additional quarterly reports that detail
indicators of mental health consumer outcomes and mental health system performance at the
county level. Reports will be developed for each California county and municipality administering
MHSA programs, which include a refined set of priority indicators appropriate for county level
performance monitoring, These reports – available to county representatives, clients, families,
stakeholders, policy makers, providers, and the like – will be designed to provide an in‐depth look
at indicators of the outcomes of their consumers and the performance of their community mental
health system.
75 |
Appendix A – California Counties that Participated in the Data Quality
Assurance Report Exercise
County
County Identification
Number
1) Alameda 1
2) Butte 4
3) Calaveras 5
4) Contra Costa 7
5) Fresno 10
6) Glenn 11
7) Kings 16
8) Lake 17
9) Los Angeles 19
10) Marin 21
11) Mariposa 22
12) Napa 28
13) Placer 31
14) San Benito 35
15) San Bernardino 36
16) San Francisco 38
17) San Joaquin 39
18) San Mateo 41
19) Santa Barbara 42
20) Santa Clara 43
21) Santa Cruz 44
22) Sierra 46
23) Siskiyou 47
24) Solano 48
25) Stanislaus 50
26) Trinity 53
27) Tulare 54
28) Tuolumne 55
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Appendix B – Account of Counties Included in Priority Indicator Calculations
Requiring CSI or DCR Data
1.2 Education and Employment: Employment Status
77 |
2.1 Homelessness and Housing
78 |
3.1 Justice Involvement
79 |
4.1 Emergency Care: Emergency Intervention for Mental Health Episodes
80 |
6.1 Access: Demographic Profile of Consumers Served
CSI DCR
County
81 |
yticinhtE
0.01‐C
ecaR
0.30‐C
htriB
fo
etaD
0.50‐C
redneG redneG
A_yticinhtE B_yticinhtE
ecaR
puorG_egA
Alameda (1) nr nr nr nr
Butte (4) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51)
Calaveras (5) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) x x x (cid:51)
Contra Costa (7) x x (cid:51) (cid:51) (cid:51) x x x (cid:51)
Fresno (10) x (cid:51) x x (cid:51) x x x (cid:51)
Glenn (11) x nr x x x x x x x
Kings (16) nr nr nr nr x x x nr nr
Lake (17) (cid:51) (cid:51) (cid:51) (cid:51) x x x x (cid:51)
Los Angeles (19) x x (cid:51) (cid:51) (cid:51) x x x (cid:51)
Madera (20) x x x x (cid:51) (cid:51) (cid:51) (cid:51) (cid:51)
Marin (21) nr nr nr nr
Mariposa (22) x (cid:51) (cid:51) (cid:51) (cid:51) nr x (cid:51) (cid:51)
Napa (28) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) x x (cid:51)
Placer (31) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) x x (cid:51) (cid:51)
San Benito (35) x x x x
San Bernardino
(cid:51) (cid:51)
(36) x x x x x x (cid:51)
San Francisco (38) (cid:51) nr (cid:51) (cid:51) (cid:51) x x x (cid:51)
San Joaquin (39) nr x (cid:51) (cid:51) (cid:51) x x nr nr
San Mateo (41) x
Santa Barbara (42) nr nr nr nr
Santa Clara (43) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51)
Santa Cruz (44) (cid:51) (cid:51) (cid:51) (cid:51)
Sierra (46) x x (cid:51) (cid:51) (cid:51) x x (cid:51) (cid:51)
Siskiyou (47) (cid:51) (cid:51) nr nr x x x x (cid:51)
Solano (48) x (cid:51) (cid:51) (cid:51) (cid:51) x x nr (cid:51)
Stanislaus (50) nr nr (cid:51) (cid:51) (cid:51) x x nr nr
Trinity (53) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51)
Tulare (54) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) x x (cid:51) (cid:51)
Tuolumne (55) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51) (cid:51)
6.2 Access: New Consumers by Demographic Profile
82 |
6.3 Access: Penetration Rate
83 |
6.4 Access: New High Need Consumers
84 |
6.5 Access: Access to Primary Care Physician
85 |
7.1 Performance: Consumers Served Annually through CSS
86 |
7.3 Performance: 24‐Hour Care
87 |
Appendix C – Results from Verified and Unverified County Data
Priority Indicator: 1.2 – Education/Employment: Proportion Participating in Paid
and Unpaid Employment (TAY, Adult, Older Adult)
Table 1.2 1. Proportion of Consumers Employed (Paid and Unpaid) (TAY, Adult, Older Adult)
Verified
Age Group All Consumers (CSI) FSPs (DCR)
FY 20082009 FY 20092010 FY 20082009 FY 20092010
TAY 526 (5.08%) 585 (4.85%) 39 (6.46%) 35 (4.31%)
Adult 1760 (7.83%) 1602 (6.67%) 69 (5.49%) 69 (4.47%)
Older Adult 86 (3.33%) 92 (2.87%) 2 (1.64%) 1 (.58%)
Total 2373 2279 110 105
Unverified
Age Group All Consumers (CSI) FSPs (DCR)
FY 20082009 FY 20092010 FY 20082009 FY 20092010
TAY 1959 (4.11) 2558 (4.12%) 340 (7.87%) 491 (7.91%)
Adult 6747 (6.36%) 8321 (6.61%) 431 (4.72%) 662 (4.93%)
Older Adult 413 (3.0%) 510 (2.94%) 35 (2.39%) 49 (2.61%)
Total 9119 11389 806 1202
Table 1.2 2. Proportion Participating in Paid and Unpaid Employment (TAY, Adult, Older Adult)
Verified
Age All Consumers (CSI) FSPs (DCR)
Group FY 20082009 FY 20092010 FY 20082009 FY 20092010
Paid Unpaid Paid Unpaid Paid Unpaid Paid Unpaid
TAY 514 16 575 10 34 7 29 6
(97.72%) (3.4%) (98.92%) (1.71%) (87.18%) (17.95%) (82.85%) (17.15%)
Adult 1722 38 1567 37 62 7 60 11
(97.84%) (2.16%) (97.82%) (2.31%) (89.86%) (10.14%) (86.96%) (13.04%)
Older 78 8 83 9 2 0 1 0
Adult (90.70%) (9.30%) (90.21%) (9.78) (100%) (0%) (100%) (0%)
Total 2314 62 2225 56 98 14 90 17
Unverified
Age All Consumers (CSI) FSPs (DCR)
Group FY 20082009 FY 20092010 FY 20082009 FY 20092010
Paid Unpaid Paid Unpaid Paid Unpaid Paid Unpaid
TAY 1935 26 2519 41 319 22 462 34
(98.77%) (1.33%) (98.48%) (1.60%) (6.47%) (6.47%) (94.09%) (6.92%)
Adult 6576 182 8108 227 346 85 513 114
(97.47%) (2.70%) (97.44%) (2.73%) (80.28%) (19.72%) (82.48%) (18.32%)
Older 371 43 468 46 26 9 35 14
Adult (89.83%) (10.41%) (91.76%) (9.02%) (74.29%) (25.71%) (71.43%) (28.57%)
Total 8882 251 11095 314 691 116 1010 162
88 |
Table 1.2 3. Proportion Participating in Paid Employment (TAY, Adult, Older Adult)
Verified
Age Group All Consumers (CSI) FSPs (DCR)
FY 20082009 FY 20092010 FY 20082009 FY 20092010
TAY 514 (97.72%) 575 (98.92%) 34 (87.18%) 29 (82.85%)
Adult 1722 (97.84%) 1567 (97.82%) 62 (89.86%) 60 (86.96%)
Older Adult 78 (90.70%) 83 (90.21%) 2 (100%) 1(100%)
Total 2314 2225 98 90
Unverified
Age Group All Consumers (CSI) FSPs (DCR)
FY 20082009 FY 20092010 FY 20082009 FY 20092010
TAY 1935 (98.77%) 2519 (98.48%) 319 (6.47%) 462 (94.09%)
Adult 6576 (97.47%) 8108 (97.44%) 346 (80.28%) 513 (82.48%)
Older Adult 371 (89.83%) 468 (91.76%) 26 (74.29%) 35 (71.43%)
Total 8882 11095 691 1010
Table 1.2 4. Proportion Participating in Unpaid Employment (TAY, Adult, Older Adult)
Verified
Age Group All Consumers (CSI) FSPs (DCR)
FY 20082009 FY 20092010 FY 20082009 FY 20092010
TAY 16(3.4%) 10(1.71%) 7 (17.95%) 6 (17.15%)
Adult 38(2.16%) 37(2.31%) 7 (10.14%) 11 (13.04%)
Older Adult 8(9.30%) 9(9.78) 0(0%) 0(0%)
Total 62 56 14 17
Unverified
Age Group All Consumers (CSI) FSPs (DCR)
FY 20082009 FY 20092010 FY 20082009 FY 20092010
TAY 26(1.33%) 41(1.60%) 22 (6.47%) 34 (6.92%)
Adult 182 (2.70%) 227 (2.73%) 85 (19.72%) 114 (18.32%)
Older Adult 43 (10.41%) 46(9.02%) 9 (25.71%) 14 (28.57%)
Total 251 314 116 162
Priority Indicator: 2.1 – Homelessness/Housing: Housing Situation
Table 6. Number of Consumers Experiencing Homelessness During Year
Verified
Age Group All Consumers (CSI) FSPs (DCR)
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Child 62 (0.2%) 69 (0.2%) 11 (1.8%) 13 (1.6%)
TAY 490 (2.7%) 658 (3.2%) 154 (14.2%) 128 (8.8%)
Adult 2688 (6.8%) 3585 (8.3%) 167 (10.3%) 220 (9%)
Older Adult 154 (3.4%) 205 (3.8%) 18 (7.3%) 16 (4.8%)
Total 3394 (3.8%) 4517 (4.7%) 350 (9.8%) 377 (7.5%)
89 |
Not Verified
Age Group All Consumers (CSI) FSPs (DCR)
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Child 305 (0.6%) 395 (0.6%) 29 (2%) 35 (1.5%)
TAY 1299 (2.9%) 1464 (2.7%) 227 (12.4%) 259 (9.4%)
Adult 6714 (6.8%) 7942 (7.3%) 893 (18.8%) 774 (13.6%)
Older Adult 511 (3.7%) 584 (3.7%) 59 (7.4%) 44 (4.3%)
Total 8829 (4.2%) 10385 (4.3%) 1208 (13.7%) 1112 (9.4%)
Table 7. Number of Consumers in Independent Housing Situations During Year
Verified
Age Group All Consumers (CSI) FSPs (DCR)
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Child 21912 (82.7%) 23206 (83.6%) 7 (1.1%) 3 (0.4%)
TAY 13613 (74.8%) 15543 (75.3%) 128 (11.8%) 162 (11.1%)
Adult 29150 (74.3%) 31848 (74%) 449 (27.8%) 483 (19.8%)
Older Adult 3264 (72.4%) 4009 (73.9%) 80 (32.3%) 71 (21.1%)
Total 67939 (76.8%) 74606 (77%) 664 (18.6%) 719 (14.2%)
Not Verified
Age Group All Consumers (CSI) FSPs (DCR)
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Child 35789 (64.8%) 40896 (65.1%) 6 (0.4%) 5 (0.2%)
TAY 28058 (63.5%) 33459 (62.7%) 268 (14.6%) 342 (12.5%)
Adult 67139 (68%) 74004 (67.8%) 1519 (32.1%) 1606 (28.1%)
Older Adult 8154 (59.1%) 9519 (60%) 218 (27.5%) 206 (20.2%)
Total 139140 (65.7%) 157878 (65.5%) 2011 (22.8%) 2159 (18.3%)
Table 8. Number of Consumers in Foster Housing Situations During Year
Verified
Age Group All Consumers (CSI) FSPs (DCR)
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Child 2774 (10.5%) 2637 (9.5%) 26 (4.2%) 38 (4.6%)
TAY 577 (3.2%) 620 (3%) 13 (1.2%) 19 (1.3%)
Adult 37 (0.1%) 35 (0.1%) 0 (0%) 0 (0%)
Older Adult 8 (0.2%) 6 (0.1%) 0 (0%) 0 (0%)
Total 3396 (3.8%) 3298 (3.4%) 39 (1.1%) 57 (1.1%)
Not Verified
Age Group All Consumers (CSI) FSPs (DCR)
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Child 4462 (8.1%) 5055 (8.1%) 54 (3.7%) 125 (5.4%)
TAY 893 (2%) 1093 (2%) 14 (0.8%) 32 (1.2%)
Adult 55 (0.1%) 44 (0%) 0 (0%) 0 (0%)
Older Adult 15 (0.1%) 13 (0.1%) 0 (0%) 0 (0%)
Total 5425 (2.6%) 6205 (2.6%) 68 (0.8%) 157 (1.3%)
90 |
Table 9. Number of Consumers Housed During Year
Verified
Age Group All Consumers (CSI) FSPs (DCR)
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Child 25653 (96.8%) 26772 (96.4%) 133 (21.4%) 151 (18.4%)
TAY 16143 (88.7%) 18261 (88.4%) 497 (45.8%) 580 (39.7%)
Adult 31637 (80.6%) 34662 (80.5%) 970 (60%) 1164 (47.8%)
Older Adult 3804 (84.4%) 4659 (85.8%) 138 (55.6%) 147 (43.8%)
Total 77237 (87.3%) 84354 (87.1%) 1738 (48.7%) 2042 (40.4%)
Not Verified
Age Group All Consumers (CSI) FSPs (DCR)
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Child 44391 (80.4%) 50075 (79.8%) 471 (32.4%) 709 (30.7%)
TAY 36191 (81.9%) 43930 (82.3%) 1033 (56.3%) 1421 (51.8%)
Adult 76527 (77.5%) 84614 (77.5%) 3261 (68.8%) 3713 (65.1%)
Older Adult 9848 (71.4%) 11398 (71.9%) 428 (54%) 504 (49.5%)
Total 166957 (78.8%) 190017 (78.8%) 5193 (58.9%) 6347 (53.9%)
Table 9. Number of Consumers With Missing or Unknown Housing Status During Entire Year
Verified
Age Group All Consumers (CSI) FSPs (DCR)
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Child 1285 (4.8%) 1373 (4.9%) 494 (79.5%) 678 (82.5%)
TAY 1794 (9.9%) 2001 (9.7%) 523 (48.2%) 847 (58%)
Adult 5385 (13.7%) 5495 (12.8%) 624 (38.6%) 1230 (50.5%)
Older Adult 565 (12.5%) 590 (10.9%) 107 (43.1%) 186 (55.4%)
Total 9029 (10.2%) 9459 (9.8%) 1748 (48.9%) 2941 (58.2%)
Not Verified
Age Group All Consumers (CSI) FSPs (DCR)
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Child 11552 (20.9%) 13475 (21.5%) 1003 (68.9%) 1623 (70.3%)
TAY 7269 (16.4%) 8485 (15.9%) 777 (42.3%) 1279 (46.6%)
Adult 16873 (17.1%) 17738 (16.3%) 1312 (27.7%) 1855 (32.5%)
Older Adult 3492 (25.3%) 3911 (24.7%) 341 (43.1%) 501 (49.2%)
Total 39186 (18.5%) 43609 (18.1%) 3433 (38.9%) 5258 (44.7%)
Priority Indicator: 3.1–Justice Involvement
Table 3.1 1. Arrest Rate Per FSP Consumer
Verified
All Consumers (CSI) FSPs (DCR)
Age Group
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Child 1,239 (38.2%) 12 (12.9%)
TAY 607 (48.0%) 563 (24.7%)
Adult 352 (19.7%) 689 (53.0%)
Older Adult 12 (13.6%) 20 (24.1%)
91 |
Total 2,210 1,284
Unverified
All Consumers (CSI) FSPs (DCR)
Age Group
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Child 36 (5.1%) 86 (2.7%)
TAY 483 (20.1%) 614 (20.1%)
Adult 477 (30.0%) 1,432 (26.1%)
Older Adult 49 (12.5%) 100 (13.2%)
Total 1,045 2,232
Priority Indicator: 4.1 – Emergency Care: Emergency Intervention for Mental Health
Episodes
Table 4.1 1. Average Number of Annual Hospital Interventions Per Consumer
Verified
Age Group All Consumers (CSI) FSPs (DCR)
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Child 0.0 0.0
TAY 0.2 0.1
Adult 0.2 0.2
Older Adult 0.1 0.1
Total n/a n/a
Unverified
Age Group All Consumers (CSI) FSPs (DCR)
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Child 0.0 0.1
TAY 0.3 0.3
Adult 0.4 0.4
Older Adult 0.2 0.2
Total n/a n/a
Priority Indicator: 6.1 Demographic Profile of Consumers Served
Table 6.1 1. Race/Ethnicity of Mental Health Consumers
Verified
Race/Ethnicity All Consumers FSPs
FY 20082009 FY 20092010 FY 20082009 FY 20092010
White 23,844 (42.2%) 20,737 (40.5%) 229 (31.0%) 232 (26.5%)
Hispanic / Latino 15,911 (28.1%) 15,454 (30.2%) 140 (19.0%) 148 (16.9%)
Asian 3,446 (6.1%) 3,086 (6.0%) 26 (3.5%) 37 (4.2%)
Pacific Islander 67 (0.1%) 56 (0.1%) 1 (0.1%) 1 (0.1%)
Black 4,759 (8.4%) 4,336 (8.5%) 40 (5.4%) 45 (5.1%)
American Indian 625 (1.1%) 501 (1.0%) 15 (2.0%) 9(1.0%)
Multirace 3,500 (6.2%) 3,370 (6.6%) 36 (4.9%) 39 (4.5%)
Unknown/Other 4371 (7.8%) 4,183 (7.1%) 251 (34.0%) 364 (41.6%)
92 |
Total 56,523 51,175 738 875
Unverified
Race/Ethnicity All Consumers FSPs
FY 20082009 FY 20092010 FY 20082009 FY 20092010
White 212,096 (34.3%) 214,849 (33.2%) 7,449 (35.7%) 10,531 (36.1%)
Hispanic / Latino 170,963 (27.7%) 179,254 (27.7%) 5,297 (25.4%) 7,666 (26.3%)
Asian 39,109 (6.3%) 30,323 (4.7%) 1,068 (5.1%) 1,399 (4.8%)
Pacific Islander 2,078 (0.3%) 2,205 (0.3%) 58 (0.3%) 86 (0.3%)
Black 104,502 (16.9%) 108,757 (16.8%) 4,138 (19.8%) 5,301 (18.2%)
American Indian 4,097 (0.7%) 4,072 (0.6%) 200 (1.0%) 271 (.9%)
Multirace 42,864 (6.9%) 44,365 (6.9%) 1,442 (6.9%) 2,193 (7.5%)
Unknown/Other 41,842 (6.8%) 63,784 (9.9%) 1,209 (5.8%) 1,695 (5.8%)
Total 617,551 647,609 20,861 29,142
Table 6.1 2. Age of Mental Health Consumers
Verified
Age Group All Consumers FSPs
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Children 94,589 (28.6%) 96,499 (29.5%) 3,353 (23.4%) 4,773 (26.0%)
TAY 59,259 (17.9%) 59,268 (18.1%) 2,926 (20.4%) 4,075 (22.2%)
Adults 156,156 (47.1%) 149,638 (45.8%) 7,268 (50.7%) 8,596 (46.8%)
Older Adults 21,235 (6.4%) 21,400 (6.5%) 785 (5.5%) 913 (5.0%)
Unknown 2 (0.0%) 7 (0.0%) ‐‐ ‐‐
Total 331,241 326,812 14,332 18,357
Unverified
Age Group All Consumers FSPs
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Children 86,240 (25.2%) 78,725 (21.2%) 1,336 (18.4%) 2,039 (17.5%)
TAY 64,219 (18.7%) 58,997 (15.9%) 1,999 (27.5%) 2,942 (25.2%)
Adults 170,122 (49.6%) 148,030 (39.8%) 3,128 (43.0%) 5,545 (47.6%)
Older Adults 22,121 (6.5%) 20,250 (5.4%) 804 (11.1%) 1,134 (9.7%)
Unknown 131 (0.0%) 65,961 (17.7%) ‐‐ ‐‐
Total 342,833 371,963 7,267 11,660
Table 6.1 3. Gender of Mental Health Consumers
Verified
Gender All Consumers FSPs
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Female 156,516 (47.3%) 154,604 (47.3%) 5,182 (42.4%) 6,489 (42.4%)
Male 174,521 (52.7%) 172,010 (52.6%) 6,717 (55.0%) 8,308 (54.3%)
Unknown/Other 204 (0.1%) 198 (0.1%) 310 (2.5%) 498 (3.3%)
Total 331,241 326,812 12,249 15,295
Unverified
Gender All Consumers FSPs
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Female 167,295 (48.8%) 179,930 (48.4%) 4,087 (43.5%) 6,351 (43.1%)
Male 174,187 (50.8%) 191,151 (51.4%) 4,953(52.7%) 7,890 (53.5%)
Unknown/Other 1,351 (0.4%) 882 (0.3%) 350(3.7%) 498(3.4%)
Total 342,833 371,963 9,390 14,739
93 |
Priority Indicator: 6.2 Demographic Profile of New Consumers
Table 6.2 1. New and Continuing Mental Health Consumers
Verified
FY 20082009 FY 20092010
New Consumers Continuing Consumers New Consumers Continuing Consumers
All Consumers 24,151 (7.3%) 307,090(92.7%) 39,420(12.1%) 287,392(87.9%)
FSP Consumers 7,206(50.3%) 7,126(49.7%) 6,714(36.6%) 11,643(63.4%)
Unverified
FY 20082009 FY 2002010
New Consumers Continuing Consumers New Consumers Continuing Consumers
All Consumers 121,585(35.5%) 221,248(64.5%) 91,925(24.7%) 280,038(75.3%)
FSP Consumers 3,071(42.3%) 4,196(57.7%) 6,063(52.0%) 5,597(48.0%)
Table 6.2 2. Race/Ethnicity of New and Continuing Mental Health Consumers
Verified
FY 200809 FY 200910
New Consumers Continuing Consumers New Consumers Continuing Consumers
White 5,565(41.0%) 57,819(38.4%) 4,373(37.6%) 43,414(36.3%)
Hispanic / Latino 4,224(31.1%) 35,861(23.8%) 4,046(34.8%) 30,654(25.6%)
Asian 412(3.0%) 6,388(4.2%) 394(3.4%) 4,962(4.1%)
Pacific Islander 15(.1%) 278(.2%) 10(.1%) 246(.2%)
Black 1,183(8.7%) 17,745(11.8%) 992(8.5%) 12,944(10.8%)
American Indian 179(1.3%) 1,015(.7%) 121(1.0%) 788(.7%)
Multirace 1,011(7.4%) 14,556(9.7%) 896(7.7%) 12,222(10.2%)
Unknown/Other 996(7.3%) 16,903(11.2%) 806(6.9%) 14,477(12.1%)
Unverified
FY 200809 FY 200910
New Consumers Continuing Consumers New Consumers Continuing Consumers
White 17,587(41.0%) 104,960(22.5%) 15,752(39.8%) 124,905(23.7%)
Hispanic / Latino 10,601(24.7%) 57,015(12.2%) 10,569(26.7%) 66,388(12.6%)
Asian 3,081(7.2%) 13,107(2.8%) 2,724(6.9%) 16,779(3.2%)
Pacific Islander 46(.1%) 437(.1%) 41(.1%) 557(.1%)
Black 3,547(8.3%) 38,324(8.2%) 3,327(8.4%) 47,544(9.0%)
American Indian 466(1.1%) 1,944(.4%) 402(1.0%) 2,172(.4%)
Multirace 2,503(5.8%) 27,724(5.9%) 2,451(6.2%) 31,976(6.1%)
Unknown/Other 5,107(11.9%) 223,475(47.9%) 4,271(10.8%) 237,572(45.0%)
Table 6.2 3. Race/Ethnicity of New and Continuing FSP Consumers
Verified
FY 200809 FY 200910
New Consumers Continuing Consumers New Consumers Continuing Consumers
White 107(27.8%) 122(34.6%) 71(20.3%) 161(30.7%)
Hispanic / Latino 71(18.4%) 69(19.5%) 49(14.0%) 99(18.9%)
Asian 12(3.1%) 16(4.5%) 13(3.7%) 25(4.8%)
Pacific Islander 0(0.0%) 1(.3%) 0(0%) 1(.2%)
Black 16(4.2%) 24(6.8%) 16(4.6%) 29(5.5%)
American Indian 9(2.3%) 4(1.1%) 0(0%) 8(1.5%)
Multirace 18(4.7%) 18(5.1%) 15(4.3%) 24(4.6%)
Unknown/Other 152(39.5%) 99(28.0%) 186(53.1%) 178(33.9%)
Unverified
FY 200809 FY 200910
94 |
New Consumers Continuing Consumers New Consumers Continuing Consumers
White 3,398(34.4%) 4,051(36.9%) 4,630(37.3%) 5,901(35.3%)
Hispanic / Latino 2,630(26.6%) 2,667(21.1%) 3,343(26.9%) 4,323(25.9%)
Asian 540(5.5%) 609(5.6%) 556(4.5%) 965(5.8%)
Pacific Islander 32(.3%) 30(.3%) 40(.3%) 46(.3%)
Black 1,821(18.4%) 2,317(21.1%) 1,887(15.2%) 3,414(20.4%)
American Indian 63(.6%) 52(.5%) 60(.5%) 89(.5%)
Multirace 805(8.1%) 637(5.8%) 1,062(8.5%) 1,131(6.8%)
Unknown/Other 603(6.1%) 606(5.5%) 849(6.8%) 846(5.1%)
Table 6.2 4. New and Continuing Consumers by Age Group
Verified
Age FY 200809 FY 200910
Group New Consumers Continuing Consumers New Consumers Continuing Consumers
Children 13,253(31.1%) 81,336(28.2%) 2,171(32.3%) 2,602(22.3%)
TAY 51,305(17.8%) 51,305(17.8%) 1,729(25.8%) 2,346(20.1%)
Adults 19,026(44.7%) 137,130(47.5%) 2,548(38.0%) 6,048(51.9%)
Older Adults 2,331(5.5%) 18,904(6.5%) 266(4.0%) 647(5.6%)
Unknown/Other 1(0.0%) 1(0.0% 0(0%) 0(0%)
Unverified
Age FY 200809 FY 200910
Group New Consumers Continuing Consumers New Consumers Continuing Consumers
Children 36,442(30.0%) 49,798(22.5%) 1,115(18.4%) 924(16.5%)
TAY 24,330(20.0%) 39,889(18.0%) 1,422(23.5%) 1,520(27.2%)
Adults 54,160(44.5%) 115,962(52.4%) 3,015(49.7%) 2,530(45.2%)
Older Adults 6,548(5.4%) 15,573(7.0%) 511(8.4%) 623(11.1%)
Unknown/Other 105(.1%) 26(0.0%) 0(0%) 0 (0%)
Table 6.2 5. New and continuing FSP Consumers by Age Group
Verified
Age FY 200809 FY 200910
Group New Consumers Continuing Consumers New Consumers Continuing Consumers
Children 1,691(23.5%) 1,662(23.3%) 1,193(36.3%) 3,580(23.7%)
TAY 1,583(22.0%) 1,343(18.8%) 812(24.7%) 3,263(21.6%)
Adults 3,545(49.2%) 3,723(52.2%) 1,148(35.0%) 7,448(49.4%)
Older Adults 387(5.4%) 398(5.6%) 130(4.0%) 783(5.2%)
Unverified
Age FY 200809 FY 200910
Group New Consumers Continuing Consumers New Consumers Continuing Consumers
Children 709(23.1%) 627(14.9%) 727(26.9%) 1,312(14.6%)
TAY 919(29.9%) 1,080(25.7%) 623(23.1%) 2,319(25.9%)
Adults 1,145(37.3%) 1,983(12.1%) 1,154(42.7%) 4,391(49.0%)
Older Adults 298(9.7%) 506(12.1%) 197(7.3%) 937(10.5%)
Table 6.2 6. Gender of New and Continuing Mental Health Consumers
Verified
FY 200809 FY 200910
Gender New Consumers Continuing Consumers New Consumers Continuing Consumers
Female 20,926(49.2%) 135,590(47.0%) 19,123(48.5%) 135,481(47.1%)
95 |
Male 21,582(50.7%) 152,939(53.0%) 20,252(51.4%) 151,758(52.8%)
Unknown/Other 57(0.1%) 147(0.0%) 45(0.1%) 153(0.0%)
Unverified
FY 200809 FY 200910
Gender New Consumers Continuing Consumers New Consumers Continuing Consumers
Female 60,071(49.4%) 107,224(48.5%) 44,426(48.3%) 135,504(48.4%)
Male 61,176(50.3%) 113,011(51.1%) 47,200(51.3%) 143,951(51.4%)
Unknown/Other 338(0.3%) 1013(0.5%) 299(0.3%) 683(0.2%)
Table 6.2 7. Gender of New and Continuing FSP Consumers
Verified
FY 200809 FY 200910
Gender New Consumers Continuing Consumers New Consumers Continuing Consumers
Female 2,400(42.6%) 2,782(42.3%) 2,125(40.8%) 4,364(43.3%)
Male 3,053(54.2%) 3,664(55.7%) 2,796(53.7%) 5,512(54.7%)
Unknown/Other 178(3.1%) 132(2.0%) 282(5.4%) 199(1.9%)
Unverified
FY 200809 FY 200910
Gender New Consumers Continuing Consumers New Consumers Continuing Consumers
Female 2,013(43.3%) 2,074(43.7%) 3,174(41.9%) 3.177(44.3%)
Male 2,432(52.3%) 2,521(53.1%) 4,089(54.0%) 3,801(53.0%)
Unknown/Other 201(4.3%) 149(3.1%) 311(4.1%) 186(2.6%)
Priority Indicator: 6.3 – Penetration of Mental Health Services
Table 6.3 1. Penetration of Services by Gender
Verified
Female Male
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Holzer Target 502,793 504,781 412,699 412,699
All Consumers 156,516(31.1%) 154,604(30.6%) 174,521(42.3%) 172,010(41.7%)
FSP Consumers 5,182(1.0%) 6,489(1.3%) 6,717(1.6%) 8,308(2.0%)
Unverified
Female Male
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Holzer Target 578,502 584,025 492,543 486,335
All Consumers 167,295(28.9%) 179,930(30.8%) 174,187(35.4%) 191,151(39.3%)
FSP Consumers 4,087(0.7%) 4,953(0.8%) 6,351(1.3%) 7,890(1.6%)
Table 6.3 2. Penetration of Services to by Age Group
Verified
Holzer Target All Consumers FSP Consumers
FY 200809 FY 200910 FY 200809 FY 200910 FY 200809 FY 200910
Children 361,012 359,213 94,589 (26.2%) 96,499 (26.9%) 3,353(0.9%) 4,773(1.3%)
TAY 133,211 135,679 59,259 (44.5%) 59,268 (43.7%) 2,926(2.2%) 4,075(3.0%)
Adults 494,918 444,154 156,156 (31.6%) 149,638 (33.7%) 7,268(1.5%) 8,596(1.9%)
Older Adults 62,621 64,721 21,235 (33.9%) 21,400 (33.1%) 785(1.3%) 913(1.4%)
96 |
Unverified
Holzer Target All Consumers FSP Consumers
FY 200809 FY 200910 FY 200809 FY 200910 FY 200809 FY 200910
Children 303,731 305,199 86,240(28.4%) 78,725(25.8%) 1,336(0.0%) 2,309(0.8%)
TAY 123,148 124,460 64,219 (52.1%) 58,997 (47.4%) 1,999(0.1%) 2,942(2.4%)
Adults 441,460 496,571 170,122(38.5%) 148,030(29.8%) 3,128(0.0%) 5,545(1.1%)
Older Adults 55,841 57,843 22,121(39.6%) 20,250(35.0%) 804(0.0%) 1,134(2.0%)
97 |
Table 6.3 3. Penetration Rate by Race / Ethnicity
Verified
Asian Other (includes:
White Hispanic Black Pacific Islander American Indian
Multiple, Other)
FY FY FY FY FY FY FY FY FY FY FY FY FY FY
2008 2009 2008 2009 200809 200910 2008 2009 2008 2009 2008 2009 200809 200910
09 10 09 10 09 10 09 10 09 10
Holzer 35,233 36,047 27,557 27,824 2,632 2,619 13,576 13,714 416 458 687 701 3,183 3,354
Target
All 23,844 20,737 15,911 15,454 4,759 4,336 3,446 3,086 67 56 625 501 4,831 7,283
Consumers (67.7%) (57.5%) (57.7%) (55.5%) (180.8%) (165.6%) (25.4%) (22.5%) (16.1%) (12.2%) (91.0%) (71.5%) (151.8%) (217.1%)
FSP 229 232 140 148 40 45 26 37 1 1 15 45 48 52
Consumers (0.6%) (0.6%) (0.5%) (0.5%) (1.5%) (1.7%) (0.2%) (0.3%) (0.2%) (0.2%) (2.2%) (6.4%) (1.5%) (1.6%)
Unverified
Asian Other (includes:
White Hispanic Black Pacific Islander American Indian
Multiple, Other)
FY FY FY FY FY FY FY FY FY FY FY FY FY FY
2008 2009 2008 2009 200809 200910 2008 2009 2008 2009 2008 2009 200809 200910
09 10 09 10 09 10 09 10 09 10
Holzer 734,901 729,743 820,207 833,957 143,732 143,378 116,789 118,511 4,187 4,893 15,927 16,185 56,285 56,456
Target
All 212,096 214,849 170,963 179,254 104,502 108,757 39,109 30,323 2,078 2,205 4,097 4,072 58,860 59,433
Consumers (28.9%) (29.4%) (20.8%) (21.5%) (72.7%) (75.9%) (33.5%) (25.6%) (49.6%) (45.1%) (25.7%) (25.2%) (104.6%) (105.3%)
FSP 7,449 10,531 5,297 7,666 4,138 5,301 1,068 1,399 58 86 200 271 1,713 1,580
Consumers (1.0%) (1.4%) (0.6%) (0.9%) (2.9%) (3.7%) (0.9%) (1.2%) (1.4%) (1.8%) (1.3%) (1.7%) (3.0%) (2.8%)
98 |
Priority Indicator: 6.4 – Access to a Primary Care Physician
Table 6.4 1. Access to a Primary Care Physician (County Verified Data)
Verified
Current Primary Care Physician
FY 20082009 FY 20092010
All FSP Consumers 6,433 (45.3%) 8,857 (48.8%)
Age Group
FY 20082009 FY 20092010
Child 1,704 (26.5%) 2,317 (26.2%)
TAY 951 (14.8%) 1,411 (15.9%)
Adult 3,355 (52.2%) 4,571 (51.6%)
Older Adult 423 (6.6%) 558 (6.3%)
Race / Ethnicity
FY 20082009 FY 20092010
White 1,772 (27.5%) 2,507 (28.3%)
Hispanic / Latino 1,890 (29.4%) 2,694 (30.4%)
Asian 377 (5.9%) 522 (5.9%)
Pacific Islander 24 (.4%) 34 (.4%)
Black 1,617 (25.1%) 2,053 (23.2%)
American Indian 68 (1.1%) 107 (1.2%)
Multirace 291 (4.5%) 400 (4.5%)
Unknown/Other 394 (6.1%) 540 (6.1%)
Gender
FY 20082009 FY 20092010
Female 2,899 (45.1%) 4,019 (45.4%)
Male 3,431 (53.3%) 4,656 (52.6%)
Unknown/Other 103(1.5%) 182 (2.0%)
Table 6.4 2. Access to a Primary Care Physician (County Unverified Data)
Unverified
Current Primary Care Physician
FY 20082009 FY 20092010
All FSP Consumers 4,271 (57.7%) 7,233 (61.0%)
Age Group
FY 20082009 FY 20092010
Child 763 (17.9%) 1,182 (16.3%)
TAY 870 (20.4%) 1,421 (19.6%)
Adult 2,053 (48.1%) 3,788 (52.4%)
Older Adult 585 (13.7%) 842 (11.6%)
Race / Ethnicity
FY 20082009 FY 20092010
White 2,193 (51.3%) 3,554(49.1%)
99 |
Hispanic / Latino 659 (15.4%) 1,358 (18.8%)
Asian 272 (6.4%) 369 (5.1%)
Pacific Islander 9 (.2%) 14 (.2%)
Black 401 (9.4%) 705 (9.7%)
American Indian 46 (1.1%) 61 (.8%)
Multirace 447 (10.5%) 746 (10.3%)
Unknown/Other 244 (5.7%) 426 (5.8%)
Gender
FY 20082009 FY 20092010
Female 1,968 (46.1%) 3,195 (44.2%)
Male 2,187 (51.2%) 3,849 (53.2%)
Unknown/Other 116(2.7%) 189(2.6%)
Priority Indicator: 6.5 – Access to a Primary Care Physician
Table 6.5 1. Consumer Perceptions of Access to Mental Health Services
Family Member/
TAY Adult Older Adult
Caregiver
FY FY FY FY FY FY FY
20082009 20092010 2008 20082009 20092010 20082009 20092010
2009
4.35 4.07 3.99 4.18 3.81 4.28 4.05
Respondents
(n=36,292) (n=1,094) (n=24,225) (n=47,878) (n=1,612) (n=4,773) (n=2,489)
Priority Indicator: 7.1 – Consumer Served through CSS
Table 7.1 1. FSP Consumers Served Compared to those Targeted for Service
Verified
FSPs Statewide
FY 20082009 FY 20092010
FSP Consumers 14,332 18,357
FSP Targets 48,642 23,112
Percent of Target 29.5% 79.4%
Unverified
FSPs Statewide
FY 20082009 FY 20082009
All FSP Consumers 7,267 11,660
Total FSP Targets 15,271 26,732
Percent of Target 47.6% 43.6%
100 |
Table 7.1 2. FSP Consumers Served Compared to those Targeted for Service, by Age Group
Verified
Children TAY Adults Older Adults
FY 2008 FY 2009 FY 2008 FY 2009 FY 2008 FY 2009 FY 2008 FY 2009
2009 2010 2009 2010 2009 2010 2009 2010
FSP Consumers 3,353 4,773 2,926 4,075 7,628 8,596 785 913
Total FSP Targets 9,633 4,020 8,785 3,579 28,650 13,928 1,574 1,584
Percent of Target 34.8% 118.7% 33.3% 113.9% 26.6% 61.7% 49.9% 57.6%
Unverified
Children TAY Adults Older Adults
FY 2008 FY 2009 FY 2008 FY 2009 FY 2008 FY 2009 FY 2008 FY 2009
2009 2010 2009 2010 2009 2010 2009 2010
FSP Consumers 1,336 2,039 1,999 2,942 3,128 5,545 804 1,134
Total FSP Targets 3,029 5,444 3,111 6,034 5,638 11,728 3,493 3,526
Percent of Target 44.1% 37.5% 64.3% 48.8% 55.5% 47.3% 23.0% 32.1%
Priority Indicator: 7.3 – 24Hour Care
Table 7.3 1. 24Hour Care (County Verified Data)
Verified
All Consumers FSP Consumers
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Total 15,127 15,646 5,820 2,196
Age Group
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Child 659 (4.4%) 649 (4.1%) 143 (7.9%) 214 (9.7%)
TAY 2,865 (18.9%) 3,121 (19.9%) 554 (30.8%) 626 (28.5%)
Adult 10,793 (71.3%) 11,041 (70.6%) 975 (54.2%) 1,228 (55.9%)
Older Adult 810 (5.4%) 834 (5.3%) 127 (7.1%) 128 (5.8%)
Race / Ethnicity
FY 20082009 FY 20092010 FY 20082009 FY 20092010
White 5,952 (39.3%) 4,435 (28.3%) 1,313 (32.7%) 1,918 (32.5%)
Hispanic / Latino 3,077 (20.3%) 1,635 (10.4%) 856 (21.3%) 1,237 (21.0%)
Asian 821 (5.4%) 498 (3.2%) 177 (4.4%) 281 (4.8%)
Pacific Islander 67 (.4%) 13 (.1%) 6 (.1%) 20 (.3%)
Black 3,046 (20.1%) 1,528 (9.8%) 671 (16.7%) 984 (16.7%)
American Indian 85 (.6%) 82 (.5%) 46 (1.1%) 68 (1.2%)
Multirace 891 (5.9%) 976 (6.2%) 485 (12.1%) 722 (12.2%)
Unknown/Other 1,188 (7.9%) 6,479 (41.4%) 467(11.6%) 674(11.4%)
Gender
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Female 6,043 (39.9%) 6,246 (39.9%) 714 (39.7%) 901 (41.0%)
Male 9,055 (59.9%) 9,378 (59.9%) 1,000 (55.6%) 1,159 (52.8%)
101 |
Unknown/Other 29(0.2%) 22 (0.1%) 85(4.8%) 136(6.1%)
Table 7.3 2. 24Hour Care (County Unverified Data)
Unverified
All Consumers FSP Consumers
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Total 24,233 21,673 15,779 6,578
Age Group
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Child 1,061 (4.4%) 940 (4.3%) 552 (10.0%) 840 (12.4%)
TAY 4,808 (19.8%) 4,355 (20.1%) 1,108 (20.1%) 1,541 (22.8%)
Adult 16,825 (69.4%) 14,977 (69.1%) 3,440 (62.5%) 3,928 (58.1%)
Older Adult 1,524 (6.3%) 1,383 (6.4%) 404 (7.3%) 449 (6.6%)
Race / Ethnicity
FY 20082009 FY 20092010 FY 20082009 FY 20092010
White 13,219 (54.5%) 11,168 (51.5%) 3,285 (32.0%) 5,271 (34.8%)
Hispanic / Latino 3,734 (15.4%) 3,413 (15.7%) 3,181 (31.0%) 4,698 (31.0%)
Asian 1,184 (4.9%) 966 (4.5%) 583 (5.7%) 773 (5.1%)
Pacific Islander 22 (.1%) 29 (.1%) 32 (.3%) 42 (.3%)
Black 3,169 (13.1%) 2,667 (12.3%) 2,099 (20.4%) 2,728 (18.0%)
American Indian 178 (.7%) 138 (.6%) 90 (.9%) 111 (.7%)
Multirace 1,617 (6.7%) 1,551 (7.2%) 477 (4.6%) 799 (5.3%)
Unknown/Other 1,110(4.6%) 1,741 (8.1%) 528(5.1%) 737(4.8%)
Gender
FY 20082009 FY 20092010 FY 20082009 FY 20092010
Female 10,743 (44.3%) 9,519 (43.9%) 2,399 (43.6%) 2,912 (43.1%)
Male 13,468 (55.6%) 12,130 (56.0%) 3,011 (54.7%) 3,674 (54.4%)
Unknown/Other 22 (0.1%) 24 (0.1%) 94(1.7%) 172(2.5%)
Priority Indicator: 7.4 – Consumer and Family Centered Care
Table 7.4 1. Perceptions of Consumer/Family Centered Care
Family Member/
TAY Adult Older Adult
Caregiver
FY FY FY FY FY FY FY
20082009 20092010 2008 20082009 20092010 20082009 20092010
2009
4.41 4.21 4.07 4.21 3.87 4.25 4.01
Respondents
(n=36,588) (n=1,102) (n=24,669) (n=47,614) (n=1,608) (n=4,757) (n=2,489)
102 |
Priority Indicator: 7.6 – Consumer Well Being
Table 7.6 1. Perceptions of Wellbeing
Family Member/
TAY Adult Older Adult
Caregiver
FY FY FY FY FY FY FY
20082009 20092010 2008 20082009 20092010 20082009 20092010
2009
3.80 3.57 3.85 3.84 3.50 3.92 3.73
Respondents
(n=35,746) (n=1,095) (n=24,270) (n=47,012) (n=1,611) (n=4,523) (n=2,450)
Priority Indicator: 7.7 – Satisfaction
Table 7.7 1. Satisfaction with Services, be Race/Ethnicity
Family Member/
TAY Adult Older Adult
Caregiver
FY FY FY FY FY FY FY
20082009 20092010 2008 20082009 20092010 20082009 20092010
2009
4.31 3.89 4.05 4.33 3.95 4.43 4.16
Respondents
(n=35,540) (n=1,103) (n=24,694) (n=47,900) (n=1,607) (n=47.900) (n=2,485)
103 |
Appendix D – Comparisons between Counties Responding to Data
Quality Assurance Reports and Declined/ Nonrespondents
Figure E 1. Population of Counties Responding/Not Responding to Data Quality Assurance Reports
Declined/Non‐ Responding
Respondents, Counties,
13,727,705 (37.1%) 23,233,959 (62.9%)
Figure E 2. Counties Responding/Not Responding to Data Quality Assurance Reports, by Size
Category
5
6
10 6
11
9
6 Responding Counties
4
1
Declined/Non‐Respondents
104 |
Figure E 3. Counties Responding/Not Responding to Data Quality Assurance Reports, by Region
9
6
Responding Counties
2
10 Declined/Non‐Respondents
10 11
7
2 1
Superior Central Bay Area Southern Los Angeles
Figure E 4. Race Dispersion of Counties Responding/Not Responding to Data Quality Assurance
Reports
105 |
400,594,41
358,131,7
026,559,1
458,464 712,522 720,331
688,367,3
737,990,1
363,301
168,04
028,925,4
905,377,1
476,382,1
600,435
White Black or African American Asian Native Some Other Two or More
American Indian and Hawaiian and Race Races
Alaska Native Other Pacific
Islander
Responding Counties Declined/Non‐Respondents
Figure E 5. Latino Ethnicity Dispersion of Counties Responding/Not Responding to Data Quality
Assurance Reports
16,334,699
10,021,885
7,195,430
3,982,417
Hispanic or Latino (of any race) Not Hispanic or Latino
Responding Counties Declined/Non‐Respondents
Figure E 6. Gender Dispersion of Counties Responding/Not Responding to Data Quality Assurance
Reports
106 |
195,360,31
624,675,5
334,392,31
124,106,5
Male population Female population
Responding Counties Declined/Non‐Respondents
Appendix E – Priority Indicator Development Subsequent to Deliverable 2D
FROM 2D REPORT – MENTAL HEALTH SERVICES ACT
CONSUMER‐LEVEL DATA
INDICATOR CALCULATION EVALUATION: COMPILING DATA TO PRODUCE ALL
INDICATORS SOURCE(S)
PRIORITY INDICATORS
Domain 1: Education/ Employment
Indicator 1.1. Average No count of school days attended/absent is available.
Total # of expulsions/suspensions per total # of
school attendance per year CPS Instead the team calculated the average number of
unique student consumers
expulsion/suspension days per student consumer.
Indicator 1.2. Proportion Total # of employed‐paid consumers by total # of
participating in paid and by total number of work‐eligible FSP consumers
unpaid employment DCR No Change
Total # of employed‐unpaid consumers by total #
of work‐eligible FSP consumers
Domain 2: Homelessness/Housing
Indicator 2.1. Proportion Total # of children, TAY, adults, or older adults
This is a version of Recommended Ratio 5 in 2D. Days
homeless annually CSI; DCR (all consumers and FSP consumers) homeless
homeless were inconsistently tracked in data.
during the FY by total # of consumers
Indicator 2.2. Proportion Total # of children, TAY, adults, or older adults
housed/ not homeless CSI; DCR (all consumers and FSP consumers) housed No change. This is Recommended Ratio 5 in 2D.
annually during the FY by total # of consumers
Domain 3. Justice Involvement
Indicator 3.1. Proportion Total # of arrests per total # of unique consumers
No change. This is Recommended Ratio 2 in 2D.
arrested
DCR Total # of arrest events (jail, juvenile hall,
probation camp, etc.) per total # of unique FSP
This is a version of Recommended Ratio 2 in 2D.
consumers
Indicator 3.2. Proportion New data collection was proposed, thus this has been
CSI; DCR
incarcerated removed from the report.
Domain 4. Emergency Care
Indicator 4.1. Emergency This is a version ofRecommended Ratio 1. Total
Total # of hospitalizations per total # of unique
intervention for mental CSI number of hospital visits is unavailable in datasets.
mental health consumers
health episodes The denominator was changed.
107 |
FROM 2D REPORT – MENTAL HEALTH SERVICES ACT
CONSUMER‐LEVEL DATA
INDICATOR CALCULATION EVALUATION: COMPILING DATA TO PRODUCE ALL
INDICATORS SOURCE(S)
PRIORITY INDICATORS
Indicator 4.2. Emergency
New data collection was proposed, thus this indicator
intervention for co
is not included in the report.
occurring physical injury
Domain 5. Social Connectedness
Indicator 5.1. Proportion
New data collection was proposed, thus this has been
who identify family
removed from the report.
support
Indicator 5.2. Proportion
who identify community New data collection was proposed, thus this has been
support removed from the report.
SYSTEM‐LEVEL
DATA SOURCE(S) INDICATOR CACLULATION EXPLANATION OF CHANGE FROM 2D REPORT
INDICATORS
Domain 6. Access
Indicator 6.1. % of Overall and FSP service
Demographic profile of populations represented by
CSI; DCR No Change
consumers served Racial/Ethnic, Age, and Gender
Groups
Indicator 6.2. % of Overall and FSP service
Demographic Profile of populations represented by new
New Consumers CSI; DCR consumers (served less than 6 No Change
months), by Racial/Ethnic, Age,
and Gender Groups
108 |
SYSTEM‐LEVEL
DATA SOURCE(S) INDICATOR CACLULATION EXPLANATION OF CHANGE FROM 2D REPORT
INDICATORS
(Previously Indicator CSI; Estimates
7.6) Indicator 6.3. (Holzer) of Ratio of all mental health
Indicator reordered due to more appropriate conceptual fit with
Penetration of Mental Serious Mental consumers served to estimates of
Access measurement domain, noted by experts and stakeholders.
Health Services Illness (SMI) in CA need for service (SMI)
(Previously Indicator
6.3) Indicator 6.4. High Indicator removed due to redundancy with Consumer Indicators.
need consumers served
Indicator 6.5. Access to % of FSP consumers indicating
DCR No Change
Primary Care Physician access to a primary care physician
Indicator 6.6. Consumer/ Mean aggregate ratings of
Family Perceptions of CPS consumer perception of access to No Change
Access to Services services
Domain 7. Performance
Indicator 7.1. FSP • Formerly titled “Consumers Served Annually through CSS”.
Consumers Served Title changed for accuracy/specificity of data available.
DCR; County Plans Ratio of FSP consumers served to
• CSS Exhibit 6 data was reported to be unreliable by many
/ Annual Updates planned service levels
experts and stakeholders. So, service levels planned by counties
were utilized as the denominator for this indicator calculation.
Indicator 7.2. • Indicator name changed (formerly “Involuntary Care”) for
Involuntary Status California accuracy (per MHSAOC request)
DMH • Involuntary Status information only available from CA‐DMH
Rate of involuntary services per
Reports of through FY 2008‐09, thus 2009‐10 is not available for reporting
10,000 served.
Involuntary • Seclusion/Restraint information only available from 7 state
Status facilities. Because the community mental health system is the
focus of this report, seclusion/restraint will not be reported.
Indicator 7.3. 24hour % of Overall and FSP consumers
CSI; DCR No Change
care who received 24‐hr services
Indicator 7.4. Consumer
Mean aggregate ratings of Formerly titled “Appropriateness of Care”. Title changed for
and Family Centered CPS
consumer/family centered care accuracy/specificity of data available.
Care
109 |
SYSTEM‐LEVEL
DATA SOURCE(S) INDICATOR CACLULATION EXPLANATION OF CHANGE FROM 2D REPORT
INDICATORS
Indicator 7.5. Integrated • Formerly titled “Continuity of Care”. Title changed in response
Service Delivery to expert/stakeholder feedback and for accuracy/specificity of
data available.
Prevalence of planned county
County Plans / • CSI and DCR data fields proposed for analysis in deliverable 2D
strategies for achieving integrated
Annual Updates were found incomplete and unreliable. As Integrated Service
service delivery.
Delivery is an MHSA service goal, county plans were
systematically coded to assess the prevalence of county
strategies for achieving integrated service delivery.
Indicator 7.6. Consumer Mean aggregate consumer/family
CPS No Change
wellbeing rating of wellbeing
Indicator 7.7. Mean aggregate consumer/family
CPS No Change
Satisfaction rating of satisfaction with services
Domain 8. Structure
Indicator 8.1. Workforce Indicator removed due to redundancy with the work of other
composition contractors (per MHSAOC request).
Indicator 8.2. Evidence Proposed DCR data fields were reported to be unreliable by
based Practice Programs experts and stakeholders, and were found to be incomplete
County Plans / Prevalence of evidence based through our analysis. Evidence based practices were identified by
Annual Updates practices planned an expert contractor and our advisory panel. Then county plans
were coded to assess the prevalence of plans to implement
evidence based practices.
Indicator 8.3. Cultural Only 1 currently collected CPS item assesses cultural
Appropriateness of WET Plans; Prevalence of planned county appropriateness of services. Such a narrow measure would not be
Services County Plans / strategies for providing culturally instructive. Thus, county plans were systematically coded to
Annual Updates appropriate services assess the prevalence of culturally appropriate service strategies
planned.
Indicator 8.4. Recovery, Prevalence of planned county Resources were not available to conduct the additionala data
WET Plans;
wellness, and resilience strategies for promoting a collection, proposed in Deliverable 2D. Thus, county plans were
County Plans /
orientation recovery, wellness, resilience systematically coded to assess the prevalence planned strategies
Annual Updates
orientation to promote a recovery, wellness, resilience orientation
110 |
Appendix F – CSI Service Function Variables for Hospitalization
and Non-Hospitalization Designation
The following pages are from the CSI Data Dictionary. They describe services in which consumers
are enrolled, including emergency interventions. The enclosed definitions guide our designation of
“hospitalization” – use of a hospital for intervention services – and “non‐hospitalization” – use of a
non‐hospital facility for such services.
S‐06.0 SERVICE FUNCTION
PURPOSE:
Identifies the specific type of service received by the client within 24 Hour, Day, and/or Outpatient
mode of service.
FIELD DESCRIPTION:
Type: Character
Byte(s): 2
Format: XX
Required On: All Service Records
Source: Local Mental Health
VALID CODES:
24 Hour Services/Mode 05 Outpatient Services/Mode 15
10‐18 = Hospital Inpatient 01‐09 = Linkage/Brokerage
19 = Hospital Administrative Day 10‐18 = Collateral
20‐29 = Psychiatric Health Facility (PHF) 19 = Professional Inpatient Visit ‐ Collateral
30‐34 = SNF Intensive 30‐38 = Mental Health Services (MHS)
35 = IMD Basic (no Patch) 39 = Professional Inpatient Visit ‐ MHS
36‐39 = IMD With Patch 40‐48 = Mental Health Services (MHS)
40‐49 = Adult Crisis Residential 49 = Professional Inpatient Visit ‐ MHS
50‐59 = Jail Inpatient 50‐57 = Mental Health Services (MHS)
60‐64 = Residential, Other 58 = Therapeutic Behavioral Services (TBS)
65‐79 = Adult Residential 59 = Professional Inpatient Visit ‐ MHS
80‐84 = Semi‐Supervised Living 60‐68 = Medication Support (MS)
85‐89 = Independent Living 69 = Professional Inpatient Visit ‐ MS
90‐94 = Mental Health Rehab Center 70‐78 = Crisis Intervention (CI)
79 = Professional Inpatient Visit ‐ CI
Day Services/Mode 10
20‐24 = Crisis Stabilization ‐ Emergency Room
25‐29 = Crisis Stabilization ‐ Urgent Care
111 |
30‐39 = Vocational Services
40‐49 = Socialization
60‐69 = SNF Augmentation
81‐84 = Day Treatment Intensive ‐ Half Day
85‐89 = Day Treatment Intensive ‐ Full Day
91‐94 = Day Rehabilitation ‐ Half Day
95‐99 = Day Rehabilitation ‐ Full Day
The coding scheme follows the County Cost Report definitions.
COMMENTS:
For information about reporting clients, services, and providers, see Technical Supplement
TS‐F: REPORTING TIPS, Tip One.
For examples of reporting this data element, see Technical Supplement TS‐F: REPORTING TIPS, Tip
Two.
DEFINITIONS:
24 Hour Services/Mode 05
Hospital Inpatient Services provided in an acute psychiatric hospital or a distinct
acute psychiatric part of a general hospital that is approved by the
(10‐18)
Department of Health Services to provide psychiatric services.
Hospital Administrative Day Local Hospital Administrative Days are those days that a patient’s
stay in the hospital is beyond the need for acute care and there is a
(19)
lack of nursing facility beds.
Psychiatric Health Facility Psychiatric Health Facility Services are therapeutic and/or
(PHF) rehabilitation services provided in a non‐hospital 24‐hour
inpatient setting, on either a voluntary or involuntary basis. Must
(20‐29)
be licensed as a Psychiatric Health Facility by the Department of
Mental Health.
SNF Intensive A licensed skilled nursing facility which is funded and staffed to
provide intensive psychiatric care.
(30‐34)
IMD For this service function an IMD is a SNF where more than 50% of
the patients are diagnosed with a mental disorder. The federal
(Institute for Mental Disease)
government has designated these facilities as IMDs.
No Patch.
Basic (35) Organized therapeutic activities which augment and are integrated
into an existing skilled nursing facility.
With Patch (36‐39)
Adult Crisis Residential Therapeutic or rehabilitative services provided in a non‐
institutional residential setting which provides a structured
112 |
(40‐49) program as an alternative tohospitalization for persons
experiencing an acute psychiatric episode or crisis who do not
present medical complications requiring nursing care.
Jail Inpatient A distinct unit within an adult or juvenile detention facility which is
staffed to provide intensive psychiatric treatment of inmates.
(50‐59)
Residential, Other This service function includes children’s residential programs,
former SB 155 programs, former Community Care Facility (CCF)
(60‐64)
augmentation, and other residential programs that are not Medi‐
Cal certified or defined elsewhere.
Adult Residential Rehabilitative services, provided in a non‐institutional, residential
setting, which provide a therapeutic community including a range
(65‐79)
of activities and services for persons who would be at risk of
hospitalization or other institutional placement if they were not in
the residential treatment program.
24 Hour Services/Mode 05 (continued)
Semi‐Supervised Living A program of structured living arrangements for persons who do
not need intensive support but who, without some support and
(80‐84)
structure, may return to a condition requiring hospitalization. This
program may be a transition to independent living.
Independent Living This program is for persons who need minimum support in order
to live in the community.
(85‐89)
Mental Health Rehab Center This is a 24 hour program which provides intensive support and
rehabilitation services designed to assist persons 18 years or older,
(90‐94)
with mental disorders who would have been placed in a state
hospital or another mental health facility to develop the skills to
become self‐sufficient and capable of increasing levels of
independent functioning.
Day Services/Mode 10
Crisis Stabilization ‐ This is an immediate face‐to‐face response lasting less than 24
Emergency Room hours, to or on behalf of a client exhibiting acute psychiatric
symptoms, provided in a 24‐hour health facility or hospital based
(20‐24)
outpatient program. Service activities are provided as a package
and include but are not limited to Crisis Intervention, Assessment,
Evaluation, Collateral, Medication Support Services, and Therapy.
Crisis Stabilization ‐ Urgent This is an immediate face‐to‐face response lasting less than 24
Care hours, to or on behalf of a client exhibiting acute psychiatric
symptoms, provided at a certified Mental Health Rehabilitation
(25‐29)
provider site. Service activities are provided as a package and
include but are not limited to Crisis Intervention, Assessment,
Evaluation, Collateral, Medication Support Services, and Therapy.
113 |
Vocational Services Services designed to encourage and facilitate individual motivation
and focus upon realistic and attainable vocational goals. To the
(30‐39)
extent possible, the intent is to maximize individual client
involvement in skill seeking and skill enhancement, with an
ultimate goal of self‐support.
Socialization Services designed to provide activities for persons who require
structured support and the opportunity to develop the skills
(40‐49)
necessary to move toward more independent functioning.
SNF Augmentation Organized therapeutic activities which augment and are integrated
into an existing skilled nursing facility.
(60‐69)
Day Treatment Intensive Day Treatment Intensive service provides an organized and
structured multi‐disciplinary treatment program as an alternative
Half Day (81‐84)
to hospitalization, to avoid placement in a more restrictive setting,
Full Day(85‐89) or to maintain the client in a community setting.
Day Rehabilitation Day Rehabilitation service provides evaluation and therapy to
maintain or restore personal independence and functioning
Half Day (91‐94)
consistent with requirements for learning and development.
Full Day (95‐99)
Outpatient Services/Mode 15
Linkage/Brokerage Linkage/Brokerage services are activities that assist a client to
access medical, educational, social, prevocational, vocational,
(01‐09)
rehabilitative, or other needed community services.
Collateral Collateral and Mental Health Services are interventions designed to
provide the maximum reduction of mental disability and
(10‐18)
restoration or maintenance of functioning consistent with the
Mental Health Services (MHS) requirements for learning, development, independent living, and
enhanced self‐sufficiency.
(30‐38, 40‐48, 50‐57)
Therapeutic Behavioral These services are the same as collateral and Mental Health
Services (TBS) Services, except they consist of one‐to‐one therapeutic contacts
with a mental health provider and a beneficiary for a specified
(58)
short‐term period of time (shadowing), which are designed to
maintain the child/youth’s residential placement at the lowest
appropriate level by resolving target behaviors and achieving
short‐term treatment goals. The mental health provider is on‐site
and is immediately available to intervene for a specified period of
time, up to 24 hours a day, depending on the need of the
child/youth.
Professional Inpatient Visit ‐ These services are the same as Mental Health Services except the
Collateral or MHS services are provided in a non‐SD/MC inpatient setting by
professional staff.
(19, 39, 49, 59)
Medication Support Medication support services include prescribing, administering,
114 |
(60‐68) dispensing, and monitoring of psychiatric medication or biologicals
necessary to alleviate the symptoms of mental illness.
Professional Inpatient Visit ‐ These services are the same as Medication Support except the
Medication Support services are provided in a non‐SD/MC inpatient setting by
professional staff.
(69)
Crisis Intervention Crisis Intervention is a service, lasting less than 24 hours, to on
behalf of a client for a condition which requires more timely
(70‐78)
response than a regularly scheduled visit. Service activities may
include but are not limited to assessment, collateral and therapy.
Professional Inpatient Visit ‐ These services are the same as Crisis Intervention except the
Crisis Intervention services are provided in a non‐SD/MC inpatient setting by
professional staff.
(79)
For more details on these definitions, see the California Code of Regulations, Title 9, Chapter 11 and
the County Cost Report documentation.
USER/USAGE INFORMATION:
This data element is needed for detailed identification of the types of services being given as well as
for linking to cost reports.
115 |
References
1 California Mental Health Planning Council (January, 2010). Performance Indicators for Evaluating the Mental Health
System.
2 Op. cit.
3 Mental Health Services Act Evaluation: Compiling Data to Produce All Priority Indicators; November 2, 2011
4 Cowles, E. L., Harris, K., Larsen, C., and Prince, A. (2010). Assessing Representativeness of the Mental Health
Services Consumer Perception Survey.
5 Cowles, E. L., Harris, K., Larsen, C., and Prince, A. (2010). Assessing Representativeness of the Mental Health
Services Consumer Perception Survey.
6 Independent for the CSI is defined as: A = House or apartment (includes trailers, hotels, dorms, barracks, etc.); B =
House or apartment and requiring some support with daily living activities (applies to adults only);
C = House or apartment and requiring daily support and supervision (applies to adults only); and D = Supported
housing (applies to adults only).
7 Stiles, P. R. (2002). Service Penetration by Persons with Severe Mental Illness: How Should it be Measured? The
Journal of Behavioral Health Services and Research , 198-207.
8 McGee, C. (2002). Benefits of Using Prevalence Estimates in Penetration Rates. The Mental Health Program at
WICHE (pp. 1-3). Boulder: WICHE Mental Health Services.
9 Stiles, P. R. (2002). Service Penetration by Persons with Severe Mental Illness: How Should it be Measured? The
Journal of Behavioral Health Services and Research , 198-207.
10 Chalres.Holzer.com
11 Morrissey, J. K. (2007). Development of a New Method for Designation of Mental Health Professional Shortage
Areas. Chapel Hill: University of North Carolina Chapel Hill.
12 Morrissey, J., Calloway, M., Bartko, T., Ridgely, S., Goldman, H., & Paulson, R. (2002). Local Mental Health
Authorities and Service System Change: Evidence from Robery Wood Johnson Foundation Program on Chronic
Mental Health. The Milbank Quarterly , 21-32.
13 Lester, H. J. (2005). Patients' and Health Professionals' Views on Primary Care for People with Serious Mental
Illness: Focus Group Study. BMJ , 1-6.
14 Op. cit.
15 Op. cit.
16 SAMSHA. (2010). Recovery Oriented Systems of Care (ROSC) Resource Guide. Washington, DC: Substance
Abuse and Mental Health Services Administration.
17 California Association of Social Rehabilitation Agencies. (2007). Developing Systems and Services that Support
People in Wellness and Recovery. Sacramento: California Institute for Mental Health.
18 Friedmann, P. J. (1999). Organizational Correlates of Access to Primary Care and Mental Health Services in Drug
Abuse Treatment Units. Journal of Substance Abuse Treatment , 71-80.
19 Blount, A. (2003). Integrated Primary Care: Organizing the Evidence. Families, Systems and Health , 121-134.
20 Primary care physician access is not reliably track among all mental health consumers, as it is among FSP
consumers. Thus, only FSP consumers were analyzed under this indicator.
21 Friedmann, P. J. (1999). Organizational Correlates of Access to Primary Care and Mental Health Services in Drug
Abuse Treatment Units. Journal of Substance Abuse Treatment , 71-80.
22 Mojtabai, R. (2005). Trends in Contacts with Mental Health and Cost Barriers to Mental Health Care Among Adults
with Significant Psychological Distress in the United States: 1997-2002. American Journal of Public Health , 2009-
2014.
23 Cowles, E. L., Harris, K., Larsen, C., and Prince, A. (2010). Assessing Representativeness of the Mental Health
Services Consumer Perception Survey.
24 Consumer Perception Surveys were not completed by youth during FY 2009-10
25 Consumer Perception Surveys were not completed by youth during FY 2009-10
26 Hart, Mark Alan. (1974) "Civil Commitment of the Mentally Ill in California: The Lanterman-Petris-Short Act." Loyola
of Los Angeles Law Review, 93-136.
27 Op cit
28 Swanson, J. W. (2000). Involuntary Outpatient Committment and reduction of Violent Behaviorin Persons with
Severe Mental Illnesses. The British Journal of Psychiatry , 324-331
29 Op cit
30 Involuntary status information for FY 2009-10 was not available from CADMH as of the writing of this report.
31 Fenton, W. S. (1998). Randomized Trial of General Hospital and Residential Alternative Care for Patients with
Severe and Persistent Mental Illness. American Journal of Psychiatry, 516-522.
116 |
32 Cowles, E. L., Harris, K., Larsen, C., and Prince, A. (2010). Assessing Representativeness of the Mental Health
Services Consumer Perception Survey.
33 Consumer Perception Surveys were not completed by youth during FY 2009-10
34 Consumer Perception Surveys were not completed by youth during FY 2009-10
35 Adair, C. E. (2003). History and Measurement of Continuity of Care in Mental Health Services and Evidence of its
Role in Outcomes. Psychiatric Services , 1351-1356.
36 Op cit
37 Bartels, S. (2003). Improving the System of Care for Older Adults with Mental Illness in the United States.
American Journal of Geriatric Psychiatry , 486-497.
38 Becker, M. (1998). A US experience: consumer responsive quality of life measurement.
Canadian Journal of Community Mental Health, Special Supplement No. 3, 41-52.
39 Carne, B. (1998). A consumer perspective. Canadian Journal of Community Mental Health, Special Supplement
No. 3, 21-28.
40 Cowles, E. L., Harris, K., Larsen, C., and Prince, A. (2010). Assessing Representativeness of the Mental Health
Services Consumer Perception Survey.
41 Consumer Perception Surveys were not completed by youth during FY 2009-10
42 Consumer Perception Surveys were not completed by youth during FY 2009-10
43 Holcomb, WR, Parker, JC, Leong, GB. & Hogdon J. (1999). Consumer satisfaction and self-reported treatment
outcomes among psychiatric inpatients. Psychiatric Services, 49(7), 929-934.
44 Cowles, E. L., Harris, K., Larsen, C., and Prince, A. (2010). Assessing Representativeness of the Mental Health
Services Consumer Perception Survey.
45 Consumer Perception Surveys were not completed by youth during FY 2009-10
46 Consumer Perception Surveys were not completed by youth during FY 2009-10
47 Hoagwood, K. B. (2001). Evidence-based Practice in Child and Mental Health Services. Journal of Psychiatric
Services , 1179-1189.
48 Drake, R., Goldman, H., Leff, S., Lehman, A., Dixon, L., Mueser, K., et al. (2001). Implementing Evidence Based
Practices in Routine Mental Health Service Settings. Psychiatric Services , 179-182.
49 NAMI. (2003, June). Treatment and Services: Cognitive Behavioral Therapy. Retrieved April 12, 2012, from
National Alliance on Mental Illness:
50 Op cit
51 Sanderson, C. (2008). Dialectical Behavior Therapy: Frequently Asked Questions. Seattle: Behavioral Tech, LLC.
52 Koenigsberg, J. (2012). Social Skills Training. Retrieved April 12, 2012, from Encyclopedia of Mental Disorders:
http://www.minddisorders.com/Py-Z/Social-skills-training.html
53 Herkov, M. (2006). About Behavior Therapy. Retrieved April 12, 2012, from Psych Central: Learn, Share, Grow:
http://psychcentral.com/lib/2006/about-behavior-therapy/
54 Psychology Campus. (2008). Modeling Therapy. Retrieved April 12, 2012, from Psychology Campus:
http://www.psychologycampus.com/behavioral-psychology/modeling.html
55 SAMSHA. (2002). Family Psychoeducation: Implementation Resource Kit. Washington, DC: Substance Abuse and
Mental Health Services Administration.
56 RAND. (2000). Partners in Care: Hope for Those Who Struggle with Hope. Retrieved April 12, 2012, from RAND
Corporation: http://www.rand.org/pubs/research_briefs/RB4528/index1.html
57 SAMSHA. (2002). Family Psychoeducation: Implementation Resource Kit. Washington, DC: Substance Abuse and
Mental Health Services Administration.
58 IMPACT. (2011). IMPACT Key Components. Retrieved April 12, 2012, from IMPACT Evidence Based Depression
Care: http://impact-uw.org/about/key.html
59 MST. (2010). What is Multisystemic Therapy? Retrieved April 12, 2012, from Multisystemic Therapy:
http://mstservices.com/index.php/what-is-mst/what-is-mst
60 Administration for Children and Families. (2012). Treatment Foster Care. Retrieved April 12, 2012, from Child
Welfare Information Gateway: http://www.childwelfare.gov/outofhome/types/treat_foster.cfm
61 Eyeberg, S. (2006). Parent-Child Interaction Therapy. Gainesville: The University of Florida.
62 Springer, D. (2009). Wrap Around Services. Retrieved April 12, 2012, from Penn Foundation, Behavioral Health
Services: https://www.pennfoundation.org/services-programs/mental-health-services/wrap-around-services.html
63 Griner, D. a. (2006). Culturally Adapted Mental Health Interventions: A meta-Analytic Review. Psychotherapy:
Theory, Research, Practice, Training , 531-548.
64 Bhui, K., Warfa, N., Edonya, P., McKenzie, K., & Bhugra, D. (2007). Cultural Competence in Mental Health Care: A
Review of Model Evaluations. BMC Health Services Research , 1-10.
65 Op cit
66 California Association of Social Rehabilitation Agencies. (2007). Developing Systems and Services that Support
People in Wellness and Recovery. Sacramento: California Institute for Mental Health.
117 |
67 Op cit
68 Op cit
69 Lester, H. J. (2005). Patients' and Health Professionals' Views on Primary Care for People with Serious Mental
Illness: Focus Group Study. BMJ , 1-6.
70 http://www.mhsoac.ca.gov/Announcements/announcements.aspx
71 http://www.mhsoac.ca.gov/Announcements/announcements.aspx
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