Performance Improvement 2003. Center for Mental Health Services

01/01/2003

Evaluation of the Community Action Grant Program, All Phase I Grantees

The study assessed the impact of the Community Action Grant Program. Variables of interest include implementation status of all programs adopted by Phase I grantees; description of consensus building processes and implementation strategies; and barriers to consensus building and practice implementation. The evaluation included a special focus on the specific experiences of grantees targeting racial/ethnic minority populations. The contractor collected qualitative and quantitative data in order to make recommendations on the grantee reporting system, data needed from the grantees to advance CMHS’ understanding of knowledge development and the adoption of evidence-based practices, and the management of the grant program by project officers.

FEDERAL CONTACT: Neal Brown, 240-276-1960 PIC ID: 7719.1

PERFORMER: Association for the Study and Development of Community, NYD

 

Overview of the ACCESS Program

The Access to Community Care and Effective Services and Supports (ACCESS) program, evaluated the integration of service systems and their impact on outcomes for homeless persons with severe mental illness. The ACCESS program provided funds and technical assistance to nine community sites to implement strategies for system change that would promote systems integration. These experimental sites, along with nine comparison sites, received funds to support outreach and assertive community treatment for 100 clients a year for four years at each site. Data on the implementation of system change strategies were collected from 1994 to 1998 during annual visits to the sites. Data on changes in systems integration were obtained from interviews with key informants from relevant organizations in each community. Client outcome data were obtained at program entry and three and 12 months later from 7,055 program participants across the four annual client cohorts at all sites. Detailed findings from the ACCESS evaluation are presented in four journal articles discussed below

FEDERAL CONTACT: Frances Randolph, 240-276-1892 PIC ID: 4980.1

PERFORMER: R.O.W. Sciences, Inc., Rockville, MD

 

Integration of Service Systems for Homeless Persons With Serious Mental Illness Through the ACCESS Program

This study assessed core questions used in the ACCESS evaluation: Does implementation of system- change strategies lead to better integration of service systems? The study was part of the five-year service demonstration program seeking to enhance integration of services’ delivery for seriously mentally ill homeless persons. Data were gathered -- from nine randomly selected experimental sites and nine comparison sites in 15 large cities -- on the extent to which each site implemented systems integration strategies (and systems integration among community agencies) across five service sectors: mental health, substance abuse, primary care, housing, and social welfare and entitlement services. Integration was measured across all organizational relationships in the local service networks (overall systems integration) and across relationships involving the primary ACCESS grantee organization (project-centered integration). Contrary to expectations, the nine experimental sites did not demonstrate significantly greater systems integration than the nine comparison sites. However, the experimental sites demonstrated better project-centered integration than the comparison sites. Moreover, more extensive implementation of strategies for system change was associated with higher levels of systems integration as well as project-centered integration at the experimental sites and the comparison sites. The ACCESS demonstration was successful in terms of project-centered integration but not system integration.

FEDERAL CONTACT: Frances Randolph, 240-276-1892 PIC ID: 4980.2

PERFORMER: R.O.W. Sciences, Inc., Rockville, MD

 

Service Systems Integration and Outcomes for Mentally Ill Homeless Persons in the ACCESS Program

The authors evaluated the second of the two core questions around which the ACCESS evaluation was designed: Does better integration of service systems improve the treatment outcomes of homeless persons with severe mental illness? The program provided technical support and about $250,000 a year for four years to nine sites to implement strategies to promote systems integration. These sites, along with nine comparison sites, also received funds to support outreach and assertive community treatment programs to assist 100 clients a year at each site. Outcome data were obtained at baseline and three and 12 months later from 7,055 clients across four annual cohorts at all sites. Clients at all sites demonstrated improvement in outcome measures. However, the clients at the experimental sites showed no greater improvement on measures of mental health or housing outcomes across the four cohorts than those at the comparison sites. Implementation of systems integration strategies was unrelated to these outcomes. Clients of sites that became more integrated, regardless of degree or whether the sites were experimental or comparison, had progressively better housing outcomes. Interventions designed to increase systems integration in the ACCESS demonstration did not result in better client outcomes.

FEDERAL CONTACT: Frances Randolph, 240-276-1892 PIC ID: 4980.3

PERFORMER: R.O.W. Sciences, Inc., Rockville, MD

 

Lessons From the Evaluation of the ACCESS Program

The authors summarized the main findings of the ACCESS program and offer lessons for policy makers. Data from studies at the site level and the client level are summarized and synthesized with the authors’ collective experience with the ACCESS program. The results of the evaluation suggest that although service systems integration can be improved, targeted efforts to implement strategies for integration do not produce better client outcomes. Efforts to integrate service systems can be supported by their effects on some organizational relationships within the mental health service system but not by their widespread effects across human services or their direct effects on clients.

FEDERAL CONTACT: Frances Randolph, 240-276-1892 PIC ID: 4980.4

PERFORMER: R.O.W. Sciences, Inc., Rockville, MD

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