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《加州心理健康服务法案》(MHSA) 给心理健康护理带来的变化，重点关注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额外征收 1% 的税，大幅增加了对加州精神卫生保健的支持，目前每年为公共精神卫生保健带来 7 亿美元的额外收入。 MHSA 规定各县仅将 MHSA 资金用于基于“康复”理念的计划和干预措施，因此有可能从根本上改变加州的精神卫生保健系统。我们与洛杉矶县心理健康局 (LAC DMH) 合作，建议评估 MHSA 对美国人口最多的县洛杉矶的服务提供和客户结果的影响。我们的首要目标是了解 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病学家、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。我们的具体目标是： 1) 在县一级，评估 LAC DMH 如何随着时间的推移制定和实施 MHSA 临床政策； 2) 在诊所层面，评估诊所如何实施 LAC DMH 对 MHSA 的解释，以及这种实施如何改变临床文化、结构以及提供者对疾病和治疗的理解； 3）在客户层面，评估当地临床变革对客户客观结果和主观治疗体验的影响。我们采用纵向设计来评估 MHSA 实施前三年在两家接受 MHSA 资助的诊所和两家未接受资助的诊所中的变化。方法包括客户 (n=480-640) 和提供者 (n=377) 自我管理调查；对 LAC DMH 管理员 (n=28)、提供者 (n=50) 和客户 (n=50) 的定性访谈；临床互动录音（n=20 组）；民族志观察；文件分析； LAC DMH 数据库的分析。摘要：《加州精神卫生服务法》(MHSA) 代表着一项努力，即通过将“康复”概念置于严重精神疾病 (SMI) 治疗的最前沿，从根本上改变公共精神卫生保健系统。该项目的目的是研究 MHSA 对 SMI 客户及其在三年内的待遇的影响。通过研究 MHSA，我们希望提供一个全面且具有启发性的例子，说明当一项可能影响数千名患者的新政策被强加于公共精神卫生保健系统以改善护理时会发生什么。