Deliver welcoming, enriched and easily accessible services that are responsive to evolving needs to keep individuals living in communities and to sustain recovery.
To ensure that we are delivering the highest-quality outpatient mental health care, we will involve our clients, including parents of children, in decision-making and optimize our clinical assessment and interdisciplinary care planning to address the needs of people in a holistic manner (Strategy 1C.1). We will also enhance the coordination of the care being delivered through DMH with other needed services and resources from other agencies in order to build up integrated and personalized foundations for recovery (Strategy 1C.2). And finally, we will find ways to make sure treatment plans are executed in a timely manner and continuously updated; that high-quality care is delivered uniformly across communities for all ages and in a culturally competent manner; and that services are designed to do everything possible to guard against crisis, isolation, hospitalization, homelessness, prolonged or repeated involvement in the child welfare system and justice involvement (Strategy 1C.3).
Assessment and Care Planning (Strategy 1C.1)
Identify the services and pathways needed to meet the multifaceted needs of individuals.
- Emphasize a whole-person approach to assessment
- Integrate individuals’ comprehensive needs including behavioral health, physical health and social support during assessments through the lens of their culture and native language
- For children, include developmental and educational needs
- Make care plans comprehensive and interdisciplinary
- Identify appropriate roles for clinicians, peers, family members and individuals themselves
- Ensure that care planning is person-centered
- Provide culturally competent assessments to ensure the individual’s plan is unique to their needs, background and age, particularly for children and youth
Service Coordination (Strategy 1C.2)
Deliver care and coordinate with non-DMH resources to meet all needs of those we serve.
- Build care teams that are accountable and empowered to coordinate all needed services in an integrated manner
- Take responsibility for enacting treatment plans and coordinating outpatient mental health services, physical health services, substance use disorder services and any other needed clinical services and supports
- Increase alignment of outpatient care with LA County Medi-Cal managed care plans and other LA County departments and agencies to better leverage the resources available that will best serve the needs of the consumer
- Work with LA Care and HealthNet to ensure children, youth, and adult Medi-Cal beneficiaries with outpatient mental health care needs receive all types of needed health care services in an integrated and culturally competent manner
- Work with the Departments of Health Services and Public Health to holistically integrate and coordinate outpatient care for individuals with co-occurring physical health and substance use care needs
- Identify team liaisons who are accountability agents
- Ensure teams have a fixed point of responsibility for coordinating individuals’ care and linking them to resources and opportunities as indicated by their care plans
Outpatient Care (Strategy 1C.3)
Ensure that our care delivery and resource coordination efforts are effective in helping those who are in need of our care to stay in community and recover from illness.
- Ensure that outpatient care teams adhere to and respect care plans and evaluations
- Regularly assess and evaluate care plans with individuals through the lens of culture to support recovery, and staff outpatient care teams with the full range of providers, including peers
- For children, regularly assess and evaluate treatment plans with their parents or caretakers through the lens of culture and appropriate development to support achievement of developmental and educational milestones; staff outpatient care teams with the full range of providers, including parent advocates
- Design outpatient services to ensure individuals stay in communities
- Mitigate the risk of crises, isolation, hospitalization, homelessness, prolonged or repeated involvement in the child welfare system and justice involvement through coordinating services that are community-based and linked
- Provide right-sized assertive community treatment (Full Service Partnership) programs
- Ensure Full Service Partnership (FSP) programs, DMH’s version of assertive community treatment, are properly staffed to deliver the most comprehensive community-based outpatient services to individuals with the greatest needs
- Conduct culturally and linguistically specific outreach to engage underserved communities in understanding what outpatient services are available to them and how to access care
- Expand outpatient clinic hours into the evenings and weekends in order to more effectively engage these communities and provide services to enhance accessibility
- Support communities in advocating for equity of resources and services
- Evaluate the system of care to ensure it meets the needs of the most at-risk children, youth and families engaged with the Departments of Children and Family Services and Probation