This study builds on previous research (5 R01 MH 38887) on eight carefully selected community mental health service systems in Oregon. In this study 364 interviews were conducted in eight countries, four urban and four rural. Data were collected from approximately equal numbers of stakeholders in each county including administrators and directors of service providing agencies, case managers, clients, and family members. The research program's long-term objectives are fourfold: 1.) To develop reliable and valid measure of local service system effectiveness. 2.) To identify differences in the perceptions of service systems held by key stakeholder groups in community systems. 3.) To document the impact of local level interorganizational factors on the development of comprehensive community support systems. 4.) To explicate models of community support systems that are conducive to exemplary performance. The new project consists of three main tasks. First, a second wave of field studies is proposed in four of the original eight counties, two rural and two urban. The same persons and organizations will be reinterviewed so that these service delivery systems will be studied longitudinally. Data from this study should improve our understanding of how service systems adapt or fail to adapt over time. Second, the system effectiveness measures we have developed based on perceptual responses will be compared with objective measures derived from the NIMH Inventory of Small Area Social Indicators. Third, further analyses will be conducted on the eight-county data set. Besides obtaining comprehensive data on the organization and dynamics of community mental health service systems, this research should provide states and localities with guidance on how to improve system performance and client outcomes.
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