Methods: CCI consisted of three broad parts: 1) Profiling Care, 2) Cultural Competence in Children's Mental Health, and 3) Steps Toward Improving Care. Part 1 (Profiling Care) includes 3 studies of existing data. The first uses an innovative quasi-experimental design to examine how clinical care processes for children served in California's outpatient child mental health programs may vary by policy-relevant program and county organizational characteristics. Using data from medical records, the validity of Medi-Cal claims data and statewide estimates of documented care processes are explored. The other 2 studies reviewed administrative data to describe the organizational characteristics and administrative policies of 58 providers and 17 counties, thereby providing information on the context of care. Part 2 (Cultural Competence in Children's Mental Health) consisted of a qualitative study of mental health providers' knowledge and skills regarding cultural competence as well as a literature review addressing culturally competent mental health care. Additionally, part 2 relates the work from the prior two studies to a third study that will examine the relationship between cultural competency approaches and evidence-based practices for improving quality of care. Part 3 (Steps Toward Improving Care) consists of 3 studies. The first study is an ongoing examination of how counties in California are using their EPSDT resources. The second study consists of a literature review regarding quality or evidence-based interventions for addressing the mental health needs of children ages 0-5. The final study was a systematic "Stakeholder Quality Improvement Review Process" that involved collaboration with administrative, provider, and family stakeholders from three California counties.

Significance: Taken together, the studies developed by the CCI represent a multi-faceted approach to profiling the quality of mental health care for children; understanding the contextual determinants of variations in these profiles; and initiating several steps in addressing cultural, programmatic, and contextual barriers to its improvement.

Impact: With this work, the State of California Department of Mental Health may begin to meet national recommendations for assessing the adequacy of quality indices and applying them to "real world" settings to identify intervention points for improving the quality of care for children and youth in the community.

Current status: Analysis ongoing.

Principal Investigators:
Bonnie Zima, MD, MPH

Sponsored by:
State of California Department of Mental Health