Delivering on “Whatever it Takes”Los Angeles County’s Journey to Improve Mental Health Outcomes (Part 1 of 3)

In the midst of America’s ever-expanding mental health emergency, how can state and local governments design, deliver, and hold themselves accountable for effectively and equitably serving those most in need?  For Dr. Jonathan Sherin, director of the Los Angeles County Department of Mental Health (DMH), the country’s largest mental health department, one answer was to pursue an outcomes-oriented redesign of the department’s most intensive mental health services and contracts. This multi-year initiative, led by Third Sector and funded by Ballmer Group and the Los Angeles County Quality and Productivity Commission, will address the diverse needs of Los Angeles (LA) County’s most vulnerable individuals and families. This work will take place across a diverse urban-to-desert geography that is the size of Connecticut (4,758 square miles) with a population the size of North Carolina (over 10 million people). 

Third Sector’s first task was to lead DMH in the redesign of the department’s largest and most intensive outpatient supportive services program: the adult Full Service Partnerships (FSP) program. Each year these services, funded by California’s innovative Mental Health Services Act (MHSA), bring a “do whatever it takes” approach to care for approximately 7,000 adults living with severe mental illness and other associated life challenges, including homelessness and criminal justice involvement. In July 2020, this programmatic and contracting redesign will culminate in the launch of new outcomes-oriented Adult FSP services and provider contracts. These new contracts will incorporate a number of innovative service design features as well as client outcome targets tailored to specific vulnerable focal populations. As an added innovation, the program will also reward providers with financial bonuses tied to achieving the highest-priority life outcomes for their clients.

We’re excited to support the efforts of innovative public sector leaders like Dr. Sherin. Third Sector’s work transforming the Department of Mental Health’s contracts will ultimately lead to better outcomes for tens of thousands of LA County’s most vulnerable residents.” – Nina Revoyr, Executive Director - Los Angeles, Ballmer Group

Over the last 18 months, Third Sector has worked with DMH to address two goals through these new services and outcomes-oriented contracting features. 

Goal 1: Redesign the Adult FSP program to help clients with multiple diverse needs achieve their unique goals, explicitly prioritizing those with the highest level of immediate need by:

  1. Clearly defining which populations should be served by the Adult FSP program, with an explicit focus on those with the highest and most immediate needs 
  2. Developing new priority client outcome metrics to address each population’s unique needs, including increasing housing stability and reducing criminal justice involvement and the need for emergency department-based care
  3. Designing provider bonus payments that incentivize the achievement of the priority client outcomes as well as equitable care to clients with the highest levels of need 

Goal 2: Ensure that Adult FSP providers are equipped with the appropriate resources and necessary expertise to help their clients achieve their goals by:

  1. Creating new team-based service expectations and guidelines, based off of the Assertive Community Treatment (ACT) model, designed to help providers equitably serve clients with diverse and often evolving levels of need
  2. Developing a funding model that equips providers with the financial resources to successfully implement this team-based service model

The Department is already building on these innovations to redesign its FSP programs for children and older adults (collectively serving 3,000 people). We expect that these programs will also implement new outcomes-oriented contracts by July 2020. 

The collective hope is that this cross-functional approach to delivering on FSP’s “whatever it takes” creed will serve as a model for how to flexibly, equitably, and effectively serve diverse clients. More broadly, Third Sector is excited by the momentum that this transformation has generated, with other counties across California joining an FSP Learning Community to better understand and build on Los Angeles’s pioneering, county-wide outcomes-oriented approach to mental health care.

Please stay tuned for two additional blog posts that will delve deeper into the what and the how of Third Sector’s involvement in these ground-breaking, outcomes-oriented mental health innovations.

Third Sector would like to recognize the visionary leadership of Dr. Sherin and the tremendous support and input that the current adult FSP service providers and DMH staff have provided to this outcomes-oriented transformation project. We would also like to acknowledge the invaluable contributions of the following project partners: Dr. Elizabeth Bromley at the DMH-UCLA Public Mental Health Partnership, Dr. Sam Tsemberis at Pathways to Housing, Patrick Sutton at Optimas Services, and Alex Briscoe, the former Director of the Alameda County Health Care Services Agency. These project partners provided critical subject matter expertise throughout the adult FSP redesign process, including in the areas of clinical service design, new team-based staffing patterns, housing supportive services, and funding structures.