In partnership with UCLA's Center for Healthier Children, Families and communities, EMT Associates Inc. conducted the statewide evaluation of services funded by the Mental Health Services Act (MHSA; CA state proposition 63. This comprehensive evaluation profiled services, costs and outcomes statewide, and for each of the state's 58 counties. California's county-centric service delivery system required that the evaluation team work closely with county agencies and stakeholders to plan analyses, collect data, and develop procedures for maximizing comparability of county data for profiles and aggregation to the state level. More specifically, the study included a) using multiple data records to develop process and outcome performance indicators for county services focusing on Full Service Partnership (FSP) client services (mandated for the most severely challenged and hard to serve persons with mental health needs) and outcomes and the larger population of MHSA-served clients, and implement performance monitoring analyses of these data; b) developing cost estimates for all county-directed services to FSP and other mental health service recipients in each county and statewide, including profiling major cost estimates and cost differentials between levels of service intensity and quality; c) identifying levels of achievement of success in outcome indicators statewide and in individual counties; d) associating different service delivery strategies and levels of intensity/quality with performance outcomes across counties; and e) estimating cost effectiveness (i.e., cost offsets) of FSP services at the state and county levels. This comprehensive evaluation presented numerous measurement challenges: assessing and adjusting precision differentials across counties, developing multiple item measures of performance indicators from multiple record sources, developing FSP-specific expenditure estimates across multiple expenditure records that have different formats across counties, and developing cost offset estimates using multiple data archives. EMT's experience in local records analysis, including process, outcome and cost, dictated our central collaborative role in the design and implementation of this complex evaluation.
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