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Stop and answer this question: If your boss allocated money for you to set up a new case management program with the condition that you be able to show positive outcomes in no more than six months, could you?
That’s exactly what the state of California has challenged pilot mental health programs for the homeless to do. That task is daunting, but proponents of these integrative service programs are determined to give it a try. (See related stories on California’s newly passed mental health bill AB 34 and the pilot programs it sets up on pp. 7 and 10.)
One of the groups participating in the pilot program established by California’s AB 34, Turning Point Community Programs in Sacramento, has identified seven indicators of success that it is fairly confident it can influence even in the short time span given. "We are actually measuring a total of 25 elements, but within that group we have singled out about seven that we think we can impact and measure even in just a few months," says John A. Buck, MBA, executive director of Turning Point Community Programs.
Those measures are:
• number of outreach contacts, including the number of homeless mentally ill who refuse enrollment after outreach measures;
• number of days incarcerated;
• number of days spent homeless;
• number of clients accepting enrollment into addiction recovery programs;
• number of clients graduated from addiction recovery programs;
• number of clients on probation or parole.
"The most important issues we have to prove to the state Legislature before the next budget cycle are whether we can eliminate homelessness and eliminate the impact on ancillary services like law enforcement in this population," says Buck. "We want to show improvements in quality of life, but it’s not realistic to think that in five or six months we can bring a homeless, mentally ill individual into a fully benefited, half-time job. We are keeping our goals realistic and focusing on some very basic outcomes for this initial time period."
Initially, any change impressive
Those involved must remain pragmatic about outcomes, agrees Vince Mandella, BS, chief of adult systems of care at the California State Department of Mental Health in Sacramento.
"If we can show that the programs work and have a positive impact, there is a greater likelihood that the governor and the state legislators will continue the program — it’s that simple," he says.
"There is pressure to have something to say before the next budget cycle in May of this year. We just have to show a slight edge in improving basic domains of life. Are there fewer hospitalizations in this population than before AB 34? Are there fewer contacts with law enforcement? Are more homeless mentally ill people housed than before AB 34?
"If we can show even slight indications that the programs are working, it will probably serve as strong evidence that they should be continued," he adds.