California MHS Act: Impact on Practice & Organizational Culture in Public Clinics

加州 MHS 法案：对实践的影响

• 批准号: 7585793
• 负责人: JOEL T BRASLOW
• 金额: $ 62.43万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-04-01 至 2011-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7585793
• 关键词: Address; Administrator; Affect; Attention; Belief; Budgets; California; Caring; Case Study; Client; Clinic; Clinical; Collaborations; Communities; Contracts; Country; County; Databases; Deinstitutionalization; Discipline; Disease; Economics; Emotional Disturbance; Enrollment; Ethnography; Freedom; Funding; Goals; Health Expenditures; Health Services Administration; Health Services Research; Health system; Healthcare; Healthcare Systems; Income; Individual; Interview; Joints; Los Angeles; Mediating; Mental Health; Mental Health Services; Mental disorders; Mentally Ill Persons; Methods; Modeling; Movement; Nature; Organizational Culture; Outcome; Patients; Philosophy; Policies; Positioning Attribute; Process; Provider; Psyche structure; Psychiatrist; Recording of previous events; Recovery; Research Design; Research Personnel; Self-Administered; Services; Shapes; Site; Structure; Surveys; System; Taxes; Time; Universities; base; clinical practice; design; experience; improved; insight; intervention program; longitudinal design; multidisciplinary; preconditioning; programs; research study; response; severe mental illness; social; sociologist; sociology/anthropology; trend

DESCRIPTION (provided by applicant): This project will analyze the changes in mental health care brought about by the California Mental Health Services Act (MHSA), focusing on the mechanisms by which change is achieved and the impact on client outcomes. The MHSA significantly increases support for mental health care in California via an additional 1% tax on personal income above $1 million, currently generating $700 million in additional yearly revenue for public mental health care. Mandating that counties use MHSA funds only for programs and interventions based on a philosophy of "recovery," the MHSA has the potential to radically transform the mental health care system in California. In collaboration with Los Angeles County Department of Mental Health (LAC DMH), we propose to assess the impact of MHSA on service provision and client outcomes in Los Angeles, the country's most populous county. Our overarching goal is to understand both what effects the MHSA has on clients and why the observed effects occurred. We have gathered a multidisciplinary team of psychiatrists, mental health services researchers, an experienced public mental health administrator, an historian, a sociologist, and an anthropologist. Our specific aims are: 1) at the county level, to assess how LAC DMH develops and implements MHSA clinical policy over time; 2) at the clinic level, to assess how clinics implement LAC DMH's interpretation of the MHSA, and how this implementation transforms clinical culture, structure, and providers' understandings of illness and treatment; and 3) at the client level, to assess the impact of local clinical transformations on clients' objective outcomes and subjective treatment experiences. We employ a longitudinal design to assess change in the first three years of MHSA implementation in two clinics receiving MHSA funding and two not receiving funding. Methods include client (n=480-640) and provider (n=377) self-administered surveys; qualitative interviews of LAC DMH administrators (n=28), providers (n=50), and clients (n=50); audio-taped clinical interactions (n=20 dyads); ethnographic observation; document analysis; and analysis of the LAC DMH database. LAY SUMMARY: The California Mental Health Services Act (MHSA) represents an effort to radically transform the public mental health care system by putting the concept of "recovery" at the forefront of treatment for the severely mentally ill (SMI). The purpose of this project is to study the impact of the MHSA on SMI clients and their treatment over the course of three years. By studying the MHSA, we hope to provide a comprehensive and instructive example of what happens when a new policy, potentially affecting thousands of patients, is imposed upon a public mental healthcare system with the goal of improved care.

描述（由申请人提供）：该项目将分析《加利福尼亚心理健康服务法》（MHSA）带来的精神卫生保健变化，重点介绍了实现变化的机制以及对客户结果的影响。 MHSA通过对100万美元以上的个人收入的额外税增加1％的1％税，可大大增加对加利福尼亚的精神卫生保健的支持，目前为公共心理卫生保健产生7亿美元的年度收入。要求县仅根据“恢复”理念的计划和干预措施使用MHSA资金，MHSA有可能从根本上改变加利福尼亚的心理保健系统。我们与洛杉矶县心理健康部（LAC DMH）合作，我们建议评估MHSA对该国人口最多的县洛杉矶服务提供和客户成果的影响。我们的总体目标是了解MHSA对客户的影响以及观察到的影响发生的原因。我们聚集了一个由精神科医生，心理健康服务研究人员，经验丰富的公共心理健康管理员，历史学家，社会学家和人类学家组成的多学科团队。我们的具体目的是：1）在县一级，评估LAC DMH随着时间的推移如何制定和实施MHSA临床政策； 2）在诊所一级，评估诊所如何实施LAC DMH对MHSA的解释，以及该实施如何改变临床文化，结构和提供者对疾病和治疗的理解； 3）在客户一级，评估当地临床转变对客户客观结果和主观治疗经验的影响。我们采用纵向设计来评估MHSA实施的前三年的变化，并在两家获得MHSA资金的诊所中，而两家未获得资金。方法包括客户端（n = 480-640）和提供者（n = 377）自我管理调查； LAC DMH管理员（n = 28），提供商（n = 50）和客户（n = 50）的定性访谈；音频冠状临床相互作用（n = 20个二元组）；民族志观察；文档分析；和LAC DMH数据库的分析。 LIE摘要：《加利福尼亚心理健康服务法》（MHSA）代表了一种努力，通过将“恢复”的概念放在严重的精神病患者治疗的最前沿（SMI），从而从根本上改变了公共心理保健系统。该项目的目的是研究MHSA对SMI客户及其治疗的影响。通过研究MHSA，我们希望提供一个全面而有启发性的例子，说明当新政策（可能影响数千名患者）被强加于公共心理保健系统以改善护理的目标时，会发生什么情况。