A comprehensive review of county-funded mental health programs helped Santa Clara County, California, better understand the services offered across its continuum of care. Building a foundation of evidence helps the county monitor program fidelity—that is, the degree to which a program adheres to its research-based design.
In 2019, Santa Clara County’s Behavioral Health Services Department (BHSD) partnered with The Pew Charitable Trusts’ Results First initiative to assess the evidence base of interventions offered in outpatient settings for adults with mental health issues. Although BHSD was already making data-driven decisions, it hoped to take this work a step further to ensure that the right services were being delivered in the right amount to the right population.
So the department compiled a program inventory, a catalog of programs it funds in county clinics and through contracted community providers. From the start, BHSD intentionally made this process collaborative.
“Relationships with providers [in] Santa Clara County are … critical, [given that] many of our programs and services are contracted out. … As such, buy-in and full engagement with all stakeholders around the potential value of this project … was important to achieve the desired outcome,” said Todd Landreneau, director of adult and older adult services at BHSD.
One of the first steps was to map the programs being offered across the department’s continuum of care, which contains several levels of services ranging from less intensive (such as case management for adults with mental health barriers to employment) to most intensive (inpatient treatment for psychiatric disorders). BHSD asked community providers to identify discrete interventions they offered their clients.
Department staff then convened a small external work group made up of a subset of these providers to validate the list for accuracy. Once this was completed, BHSD and the work group compared the programs in the list to the evidence about what works to reduce mental health symptoms using the Results First Clearinghouse Database. Then they created profiles for the most commonly offered programs, which included fidelity markers such as number and frequency of treatment sessions and target population to be able to compare implementation across providers. For example, according to research, adults with a clinical diagnosis of depression who are receiving cognitive behavioral therapy should meet with their clinician one to two times a week for 12-20 weeks.
Through this process, BHSD identified several opportunities to improve program fidelity and standardize implementation.
“The biggest change to this work is understanding what the concept of ‘evidence-based practice’ means, using data to plan the implementation or termination of a program, and aligning … services [for] effectiveness to both the client and the department,” said Margaret Obilor, division director of adult and older adult services at BHSD.
As Santa Clara’s example shows, program inventories offer jurisdictions a way to map services across their continuum of care, compare implementation across providers, and build a foundation for monitoring fidelity. Santa Clara also demonstrates that involving providers in the process can help jurisdictions collect more accurate information, spread knowledge about program assessment, and ensure buy-in when making decisions based on inventory findings.
Sara Dube is a director and Abby Hannifan is a principal associate with the Results First Initiative.