Document Type

Capstone Project (Open Access)

Degree Name

Bachelor of Arts (B.A.)


Health, Human Services and Public Policy

First Advisor

Alicia Hernandez-Sanchez


The rate of clients discharging from acute mental health services in Monterey County is low. According to Monterey County Behavioral Health Services Act (2017), “the demand for services has greatly increased with the ACCESS programs serving 90% more individuals in the past two years [2015-2016], and a 168% increase in the last 5 years [2011-2016].” The increase in demand for services has impacted staff psychiatrist and social workers in providing quality treatment services.

The Monterey County Behavioral Health Bureau (MCBH), a division of Monterey County Health Department, has identified clients who’ve shown improvement in their mental health recovery and are eligible for lower level of care treatment. In collaboration with the agency, the “Transition to Integrated Care” project was developed with the objective to transition stable clients to their Primary Care Physicians (PCP). This process is a way of rewarding clients for their recovery and increasing access for client’s who need higher level of care.

For clients who are not eligible for lower level of care, they are being referred to Adult System of Care (ASOC) where the client remains with their current psychiatrist and additional case management services are provided by a Psychiatric Social Worker.

At the end of the transition process, clients are invited to participate in an evaluation survey that measures areas of the transition process. It is recommended that the agency continue to use the evaluation tool to gather data and improve the continuity of care for future transitions.