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The effects of Prop. 63 on mental services and outcomes
Abrams, Lauren Elizabeth
In 2004, California voters passed Proposition 63, a ballot initiative to increase funding for mental health care by taxing 1 percent of personal income over $1 million. Now called the Mental Health Services Act (MHSA), the goal was to reform California's mental health system to provide community based services and encourage an innovative, recoveryfocused, and culturally competent approach to care. This study attempts to examine if MHSA and its components have the desired impact on the target population. To investigate the question, two programs are analyzed that served similar clients using the same service model with data collected April 2007 through June 2008. Both programs used Assertive Community Treatment (ACT) as their recovery model in serving clients with mental health issues; one of the programs was funded under MHSA and the other was not. The hypothesis of this study is that the program that received MHSA funding and therefore required to follow guidelines set under MHSA will have higher fidelity to the ACT model and also have better client outcomes than the program that is funded through the larger traditional mental health department. Outcomes were measured by comparing client scores in a variety of outcome measures collected monthly by program staff, and by analyzing fidelity assessments conducted on each program. A Student's t-test was used to compare percentages of clients with improved or stable scores between the programs in several outcome areas (including mental health recovery stage, substance abuse, residential, employment, and educational status). Only one of the five outcome measures, the mental health recovery stage, showed a significant difference in the percentage of clients with "stable or improved" scores (p=.011) with a larger percent of clients in the MHSA-funded program improving or remaining stable. However, the traditionally funded ACT program scored significantly higher on the Dartmouth Assertive Community Treatment Scale, which measures program fidelity to the evidence-based model. These are mixed results and do not strongly prove or disprove the hypothesis. These mixed results raise more questions and reflect the need for further study and improved data measures. Analyzing outcomes of this unique legislation is essential to understanding the impact it has on individuals and families, their communities and the service delivery system.
Health and Human Services
Master of Social Work (M.S.W.) San Diego State University, 2011
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