This report describes development of a statewide framework for evaluating and monitoring the short- and long-term impact of prevention and early intervention funding for mental health services on the California population. It details the approach, the data sources, and the frameworks developed: an overall approach framework and outcome-specific frameworks.

To inform improvements to the quality of care delivered by the military health system for posttraumatic stress disorder and major depressive disorder, researchers developed a framework and identified, developed, and described a candidate set of measures for monitoring, assessing, and improving the quality of care. This document describes their research approach and the measure sets that they identified.

In 2004, California voters passed the Mental Health Services Act, which was intended to transform California0́9s community mental health system from a crisis-driven system to one that included a focus on prevention and wellness. The vision was that prevention and early intervention (PEI) services comprised the first step in a continuum of services designed to identify early symptoms and prevent mental illness from becoming severe and disabling. Twenty percent of the act0́9s funding was dedicated to PEI services. The act identified seven negative outcomes that PEI programs were intended to reduce: suicide, mental health-related incarcerations, school failure, unemployment, prolonged suffering, homelessness, and removal of children from the home. The Mental Health Services Oversight and Accountability Commission (MHSOAC) coordinated with the California Mental Health Services Authority (CalMHSA), an independent administrative and fiscal intergovernmental agency, to seek development of a statewide framework for evaluating and monitoring the short- and long-term impact of PEI funding on the population. CalMHSA selected the RAND Corporation to develop a framework for the statewide evaluation. This report describes the approach, the data sources, and the frameworks developed: an overall approach framework and outcome-specific frameworks.

The National Institutes of Health provided a grant to the RAND Corporation to identify the costs associated with implementation of a collaborative care treatment program for opioid and alcohol use disorders. Between 2012 and 2016, RAND studied the implementation of the substance use motivation and medication integrated treatment (SUMMIT) program in a multi-site large urban federally qualified health center (FQHC) in Los Angeles County. This report describes the costs of the program, separating the resources spent by the FQHC and the external facilitators of the SUMMIT program. The findings of this study are based on a bottom-up, activity-based costing approach to determine the staff time spent (labor costs) on the program and any minor equipment expenses. Rather than simply log all the labor and equipment costs incurred for the study, we provide the costs that another facility of this size might expect to incur. We include costs that take into account the lessons learned about how many people with particular job roles should participate in meetings, trainings, and other activities. Therefore, although the focus of this study is one larger health center in Los Angeles County, we believe other large treatment facilities and health clinics may find the results of interest as well.

Building Recovery by Improving Goals, Habits, and Thoughts (BRIGHT-2) is a manualized group cognitive behavioral therapy program for co-occurring depression and alcohol and drug use problems. BRIGHT-2 has been designed so that non0́3mental health practitioners, and practitioners with less formal training than professional mental health counselors, can deliver the program, thus providing evidence-based depression treatment to individuals who often do not receive it. BRIGHT-2 is an 18-week program consisting of three modules, each of which focuses on a specific topic0́4thoughts, activities, and people interactions0́4and how it can affect a person0́9s mood and desire to drink or use drugs. The BRIGHT-2 manual consists of a leader0́9s introduction, a session-by-session group leader manual, and a session-by-session group member0́9s workbook; this volume is the group member0́9s workbook.

The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans’ health care. The RAND Corporation was tasked with an assessment of the Department of Veterans Affairs (VA’s) current and projected health care capabilities and resources. An examination of data from a variety of sources, along with a survey of VA medical facility leaders, revealed the breadth and depth of VA resources and capabilities: fiscal resources, workforce and human resources, physical infrastructure, interorganizational relationships, and information resources. The assessment identified barriers to the effective use of these resources and capabilities. Analysis of data on access to VA care and the quality of that care showed that almost all veterans live within 40 miles of a VA health facility, but fewer have access to VA specialty care. Veterans usually receive care within 14 days of their desired appointment date, but wait times vary considerably across VA facilities. VA has long played a national leadership role in measuring the quality of health care. The assessment showed that VA health care quality was as good or better on most measures compared with other health systems, but quality performance lagged at some VA facilities. VA will require more resources and capabilities to meet a projected increase in veterans’ demand for VA care over the next five years. Options for increasing capacity include accelerated hiring, full nurse practice authority, and expanded use of telehealth.

This tool presents detailed technical specifications for the set of quality measures identified and specified in a multiyear study of the link between improvements in processes of care for alcohol misuse and improvements in outcomes, known as the AQual study. These measures were selected for testing on the basis of a literature review, the findings of a technical expert panel, and an iterative process of specification. The tool describes the overall AQual study context and goals, the specific institutional context in which the measures were developed and will ultimately be tested, and the steps taken to arrive at the final set of measures, described in terms of their denominator population as well as their required data sources.

Psychiatrists, nurse practitioners, and other prescribing clinicians who work in mental health settings are in an optimal position to treat an alcohol use disorder (AUD) that co-occurs with a primary mental health condition experienced by clients in these settings. U.S. Food and Drug Administration-approved medications are available and appropriate for use in mental health settings to enhance the effectiveness of mental health treatment. This tool provides a "how-to" guide to identifying and treating clients with a co-occurring alcohol use disorder in mental health settings. It also includes a prescriber summary that defines a strategy for prescribing AUD medications in mental health settings. This guide is divided into three parts. In Part I, the authors include information about identifying and diagnosing an AUD. In Part II, they review administering naltrexone long-acting injection, and in Part III, they review oral medications for AUD.