This report examines the reach and impact of Mental Health Service Act--funded programs in Los Angeles County, with a focus on prevention and early intervention programs for children and transition-age youth (TAY) and Full-Service Partnership programs for children, TAY, and adults.

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Evaluation of the Mental Health Services Act in Los Angeles County

Implementation and Outcomes for Key Programs

by J. Scott Ashwood, Sheryl H. Kataoka, Nicole K. Eberhart, Elizabeth Bromley, Bonnie T. Zima, Lesley Baseman, F. Alethea Marti, Aaron Kofner, Lingqi Tang, Gulrez Shah Azhar, et al.

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Research Questions

  1. How can LAC DMH improve the implementation of major MHSA-funded activities?
  2. Is LAC DMH meeting the needs of the Los Angeles community it serves?

Los Angeles County used Mental Health Services Act (MHSA) funds to greatly expand access to Full-Service Partnership (FSP) services and offer new prevention and early intervention (PEI) services. This report examines the reach of key MHSA-funded activities and what the impact of those activities has been, with a focus on PEI programs for children and transition-age youth (TAY) and FSP programs for children, TAY, and adults.

The evaluation found evidence that the Los Angeles County Department of Mental Health (LAC DMH) is reaching the highly vulnerable population it seeks to reach with its FSP and youth PEI programs. Furthermore, those reached by the programs experience improvements in their mental health and life circumstances. Refining data collection will enable more-thorough evaluation of processes of care and would inform the program's quality-improvement efforts.

Key Findings

PEI Programs for Children and TAY

  • LAC DMH's PEI programs provided services to almost 130,000 youth, the vast majority of whom were members of ethnic minorities. Almost 65 percent of these clients were new clients, suggesting that PEI programs are successfully reaching youth who have not previously gotten care.
  • Utilization of treatments, such as therapy and case management, increased with use of PEI programs.
  • PEI programs are associated with staying well and getting better. Of those receiving preventative care (i.e., those who scored below a widely used threshold for psychological distress at entry into care), almost nine out of ten remained below the threshold for clinically significant symptoms over time. Of those who had symptoms levels at or above a clinical cut point for psychological distress at the start of their PEI service, more than half no longer had clinically significant symptoms after care.
  • Hispanic and Asian youth responded particularly well to PEI services, in comparison to white and black youth. However, all racial/ethnic groups experienced significant improvements in symptoms.

FSP Programs for Children, TAY, and Adults

  • FSP enrollment increased over the five years evaluated for children, TAY, and adults. Further, the majority of those enrolled actively engaged in the program.
  • FSP programs provide services to vulnerable and diverse populations. The programs are located throughout the county, but they are primarily in areas with more households in poverty, where LAC DMH services are likely to be needed the most. The individuals served by the programs tend to have severe diagnoses (e.g., psychotic disorders) and relatively high rates of homelessness. Qualitative interviews also revealed that FSP clients were simultaneously experiencing problems with mental health, physical health, and social issues. The programs predominately serve racial/ethnic minorities.
  • FSP clients experienced improvements in their life circumstances and functioning. FSP clients experienced decreased rates of homelessness and justice system detention, as well as decreased utilization of inpatient hospitalization for mental health. Adults in particular had increased rates of having a primary care provider, suggesting a better connection to physical health care.

Recommendations

  • Continue LAC DMH's efforts to reach vulnerable populations across the county and improve outcomes for diverse racial/ethnic groups.
  • Facilitate future outcome-monitoring and quality-improvement efforts by retooling the approach to measuring outcomes.
  • Measure processes of care and using data for quality improvement.
  • Examine provider-level differences in engagement and outcomes.
  • Conduct cost-effectiveness and cost-benefits analyses.

Table of Contents

  • Chapter One

    Background

  • Chapter Two

    Methods

  • Chapter Three

    Results: Reach and Outcomes of Prevention and Early Intervention for Youth

  • Chapter Four

    Results: Reach and Outcomes of Full-Service Partnerships for Children and Transition-Age Youth

  • Chapter Five

    Results: Reach and Outcomes of Full-Service Partnerships for Adults

  • Chapter Six

    Lessons Learned, Recommendations, and Conclusions

  • Appendix A

    Clinical Data Set

  • Appendix B

    Reduction of Clinically Significant Symptoms from Baseline for PEI Practices, Using General and Specific Outcome Measures

The research described in this report was funded the California Mental Health Services Authority (CalMHSA) and conducted by RAND Health.

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