Policy shifts and organizational adaptation: a review of current developments.

Changes in the operations and structure of local mental health centers are occurring in response to policy and funding shifts at the state and federal levels. Clinical and administrative staffing changes reflect both cutbacks in funding for traditional outpatient and inpatient services, as well as increases in partial care, community, residential and case management services. Centers are diversifying their funding sources, especially through increased revenues from Medicare-Medicaid sources. Governing boards remain active in center policy making, with few changes in their composition. Current adaptation strategies focus mainly on enhancing efficiency, reviewing service costs, expanding services to more viable markets, and improving business practices. These actions and strategies are compared to findings from previous studies, and their implications are discussed.