Full Service Partnership
LA County Full Service Partnership (FSP) programs have improved the lives of tens of thousands of clients since inception in 2006. FSP programs focus on providing whatever it takes to clients with lengthy recent histories of incarcerations, hospitalizations, homelessness as well as children with academic difficulties due to a Serious Emotional Disturbance. Our results demonstrate that after enrollment in an FSP:
• Adult clients spent 71% fewer days homeless
• Older Adult clients spent 44% fewer days in jail
• Child clients spent 39% fewer days hospitalized
• TAY clients spent 60% fewer days in juvenile hall
• The percent of child clients with good to very good grades increased by 31% after the first year of FSP.
Mental Health Urgent Care Centers
Funded through LA’s MHSA Community Services and Supports Plan, Mental Health Urgent Care Centers provide a full array of crisis, mental health, psychiatric and linkage services to reduce the likelihood of unnecessary psychiatric emergency department or inpatient admissions. Urgent Care Centers have served as a hub for law enforcement to bring individuals in crisis for an evaluation as well as a resource for inpatient facilities. Data for clients served in FY 2014/14 shows that only 11% of clients admitted to a psychiatric inpatient facility within 30 days of their Urgent Care Center visit.
To meet the needs of clients from specific Asian Pacific Islander (API) communities, a specialized API FSP Provider Collaborative was developed that matches the cultural and linguistic needs of clients across the county to specific providers.
The constellation of services and the overall approach that is FSP has been replicated to serve chronically homeless, highly vulnerable adults with co-morbid medical, mental health and substance use conditions and will serve as the treatment model for our Assisted Outpatient Treatment program.
Prevention and Early Intervention
Prevention and Early Intervention has resulted in the adoption of 32 Evidence-Based, Promising and Community-Defined Practices as well as allowed for the Department to implement Stigma and Discrimination reduction programs, suicide prevention services and a unique school mental health violence reduction program called START which provides consultation and assessment services to schools, levels K-University on violence risk and suicide risk.
Reduction in Suicidal Risk Level
START rated clients low, medium, or high on their suicidal risk levels during the initial assessment as well as after START and other services were provided. Seven (6%) clients remained at the same suicidal risk level, 47 (42%) lowered the risk by one level, and 58 (52%) by two levels.
Reduction in Risk Level for Danger to Others
START rated clients low, medium, or high on homicidal risk levels during the initial assessment as well as after START and other services were provided.181 (85%) clients were rated the same risk level for danger to others at pre and post assessments. The 181 clients remained at low homicidal risk level, received brief intervention and were referred to appropriate service agencies. Additionally, 31 clients were provided intensive case management services. Of the 31 clients, 25 (12%) lowered homicidal risk by one level, 4 (2%) by two levels, and 2 (1%) increased by one level.
Outcomes for Selection Early Intervention Practices:
PEI metrics were chosen based on input from practice developers, a review of the outcome measure literature and input from providers and other stakeholders. In addition, cost, length of instrument and languages an instrument has been translated into were factors related to measures selection.
A general measure and focus of treatment specific measure is administered at the beginning of treatment and at the end of treatment, with pre- and post-treatment changes analyzed. If the treatment lasts greater than six months, both measures are given again at the six-month marker.
The MHSA Implementation and Outcomes Division provides regular training on the use of outcome measures for PEI and use of the PEI OMA web-based application in the form of in-person training as well as webinars and written guides. For more information on PEI outcome user support, use the following link www.dmhoma.pbworks.com.
LAC DMH’s MHSA Implementation and Outcomes Division has developed opportunities for providers to utilize outcome data to enhance their services and to better understand PEI outcome reports.
LAC DMH has staged the production of PEI outcome reports, prioritizing reports developed for Service Area Outcome Data Workgroups and PEI Practice Learning Networks that LAC DMH has implemented over the last 2-3 years. Below is a summary of outcomes associated with the PEI practices associated with the Service Area Outcome Data Workgroups or the learning networks:
Managing and Adapting Practice (MAP)*: This practice encompasses several foci of treatment, including anxiety, trauma, depression and disruptive behavior disorders. While the matched pairs are relatively low at this point, both children and parent/caregivers have endorsed the strongest positive change related to the treatment of disruptive behavior disorders, with 67% of parents endorsing positive change on the Youth Outcome Questionnaire (YOQ) and 57% endorsing positive change on the Eyberg Child Behavior Inventory (ECBI), 40% of children endorsing positive change on the YOQ-SR, and 55% endorsing positive change on the ECBI. Overall, matched pair results to date indicate that parent/caregivers are endorsing positive change related to MAP 64% of the time, with a 45% improvement in functioning achieved and children are endorsing positive change 55% of the time, with a 41% improvement in functioning achieved. All comparisons are made at the beginning and at the end of treatment.
Triple P Parenting*: This practice aimed at reducing parenting and family difficulties has resulted in a 38% positive change as endorsed by parents and a 22% positive change as endorsed by children on the YOQ-SR. The practice has also demonstrated 58-60% positive reliable change in parent/caregiver ECBI scores.
Trauma Focused Cognitive Behavioral Therapy*: For the 64 agencies providing trauma focused services, 74% of the recipients of this practice self-identify as Latino. Both children and parent/caregivers have endorsed positive change on the YOQ. Parents endorsed a 38% improvement in their children’s overall functioning, while children reported a 35% improvement in their overall functioning, representing 51% and 47% reliable change percentage, respectively. On average, parents report a 37% improvement and children report a 42% improvement in trauma symptoms on the Post Traumatic Stress Disorder Reaction Index (PTSD-RI) after completing Trauma Focused Cognitive Behavioral Therapy.
Incredible Years: This practice, aimed at improving parenting skills and reducing family difficulties, has been implemented at 17 provider sites and has an average client age of 8. Sixty-five percent of clients are male and 81% are Latino. A comparison between pre and post-average scores for the ECBI and the YOQ shows a reduction in symptoms below the clinical cutoff. Reductions in average scores range from 17% to 33%.
Group CBT for Depression: This practice aimed at reducing early course depression, implemented by 16 providers, has demonstrated on average a 35% reduction in symptoms as measured by the PHQ-9 and a 21% reduction in overall symptoms as measured by the Outcome Questionnaire (OQ-45.2), representing 38% to 43% positive reliable change respectively.
Individual CBT: 58 providers have implemented this practice for children and adults to treat early course depression, anxiety or trauma.
Aggression Replacement Training (ART): Sixteen agencies are providing this practice aimed at treating disruptive behavior disorders in 12-17 year olds. When comparing pre and post-treatment average scores for the ECBI, the practice has led to 14 to 25% reductions in symptoms and 11 to 25% reductions in average scores pre and post-treatment on the YOQ-Parent and YOQ-SR.
Seeking Safety: A robust implementation involving 87 contract agencies and county-operated programs has demonstrated, as measured by the PTSD-RI and the Outcome Questionnaire/YOQ-SR & YOQ (parent and self-report), significant reductions in trauma. Average symptom reduction after completion of the practice for children and their parent/caregiver ranges from 29% to 35% depending upon the questionnaire. Average symptom reduction for adults aged 18 and above is 20%, with reductions seen below the clinical cutoff for the PTSD-RI for adults.
Child Parent Psychotherapy: Thirty-seven contract agencies and county operated programs are providing this practice geared to treat trauma in young children ages 0–6 and their parent/caregivers. This practice has yielded a 62% improvement in trauma symptoms as measured by the YOQ-Parent.
Crisis Oriented Recovery Services (CORS): Thirty-eight contract and county operated programs are providing this brief treatment model to address situational crises. Adults and children who completed the six session model experience a 21% improvement as measured by the OQ 45.2 and YOQ-SR respectively. Parents reported a 33% improvement in their child’s symptoms.
*Due to the conversion of outcome data from CiMH to the LACDMH PEI Outcome Measure Application, these outcomes reported are from the last reports produced by CiMH. It is estimated that the data migration will be completed and a report produced in late spring, 2015.
MHSA Housing Program: Building Hope and ending Homelessness: A 2012 Impact Report
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Profiles of Hope
In 2010, the Los Angeles County Department of Mental Health’s Public Information Office created and produced the Profiles of Hope broadcast television series as an anti-stigma and discrimination tool on mental health and recovery.
A total of twelve high-profile personalities, experienced and passionate advocates in promoting hope, wellness and recovery, donated their time and talent to create the Profiles series. The series highlights their individual struggles with mental illness; what was experienced in personal and family lives and how each individual coped and ultimately thrived. The testimonials encourage others to seek help, if needed, and ask the community to “re-think” traditional stereotypes about those suffering from mental illnesses, aiming to create open discussion about support and tolerance of those diagnosed with a mental illness.
The Profiles of Hope project shows that anyone could be subject to the stigma mental illness has traditionally carried and changes minds about how to support and view others with a diagnosis of mental illness.
In addition to the ten-minute segments, individual Public Service Announcements (PSAs) were created to strengthen LACDMH's message of hope, wellness and recovery within the community.
Originally shown on PBS in Los Angeles, the Profiles series has garnered two L.A. Area Emmy Awards, one Silver Telly Award and a Nevada-California cable award and has been growing:
• The California State University Provost requested DVD’s of the Profiles for distribution to all Cal State campuses to use as a learning tool.
• Other states have requested the programs, as have multiple Southern California cable operators to show the videos in various public forums and on broadcast television (cable and PBS).
• The LA County Channel gaveDMH an hour of daily programming where they show the Profiles daily.
• Clinics and other DMH programs show them in their lobbies and at conferences.
• Without any advertising or formal marketing, our videos have a high number of views: Rick Springfield’s Profile has over 64,000 views.
The videos are available on the DMH website and on our YouTube channel: LACDMH PIO