How a Stressed Local Public System Copes With People in Psychiatric Crisis

In order to bolster the public mental health safety net, we must first understand how these systems function on a day-to-day basis. This study explored how individual attributes and organizational interdependencies within one predominantly urban US county affected responses to individuals’ needs during psychiatric crises. We interviewed clinicians and managers within the crisis response network about people at immediate risk of psychiatric hospitalization, what had happened to them during their crises, and factors affecting services provided (N = 94 individuals and 9 agencies). Social network diagrams depicted patterns of referrals between agencies. Iterative coding of interview transcripts was used to contextualize the social network findings. Often, agencies saw crises through to resolution. However, providers also limited the types of people they served, leaving many people in crisis in limbo. This study illustrates how attributes of individuals with mental illness, service providers and their interactions, and state and federal policies intersect to shape the trajectories of individuals during psychiatric crises. Understanding both the structures of current local systems and their contexts may support continued evolution toward a more humane and robust safety net for some of our society’s most vulnerable members

Providers’ Attitudes Toward Evidence-Based Practices: Is it Just About Providers, or Do Practices Matter, Too?

Evidence-based practice (EBP) attitudes were measured in a sample of Los Angeles County mental health service providers. Three types of data were collected: provider demographic characteristics, attitudes toward EBP in general, and attitudes toward specific EBPs being implemented in the county. Providers could reliably rate characteristics of specific EBPs, and these ratings differed across interventions. Preliminary implementation data indicate that appealing features of an EBP relate to the degree to which providers use it. These findings suggest that assessing EBP-specific attitudes is feasible and may offer implementation-relevant information beyond that gained solely from providers' general attitudes toward EBP

A Micro-Level Perspective on Joint Inspections : How Teamwork Shapes Decision Making

In street-level bureaucracy studies, inspectors are often seen as frontline workers with individual discretion. Inspectors, however, increasingly operate in intra- or inter-organizational teams and perform joint inspections to more effectively tackle the complexity of multi-problems and wicked issues in society. Nevertheless, how street-level bureaucrats work together in teams, and how teamwork shapes decision making on the ground has not been given much scholarly attention in public administration. Based on findings from the few published studies on this topic, this chapter argues that the social dynamics and decision-making processes in joint inspections may be different than those in one-on-one inspector–inspectee encounters. It therefore calls for more research to better understand how teamwork shapes decision-making at the micro-level, and how challenges can be dealt with