Title Pending 6419

This is an accepted article with a DOI pre-assigned that is not yet published.Introduction. Ohio has a behavioral health system of county operated and state-supervised boards that plan, fund, and evaluate mental health and addiction services. This research evaluates the continuous improvement initiatives at Stark County Mental Health and Addiction Recovery Board (StarkMHAR).  We examined the following research questions: 1) Were the process improvement interventions effective in moving the organization(s) toward its goals?  2) Were the productivity interventions effective in improving productivity across the organizations?  3) Were the workforce development interventions effective in moving the organization(s) toward its goals?  4) What was the impact of the leadership initiatives on the participants?  Methods: A multifaceted mixed methods evaluation was conducted between August 2020 to December 2023. We collected quantitative data over four state fiscal years (SFY) to measure process improvement, productivity, and workforce. We used survey methods with open and closed-ended questions to evaluate the leadership initiatives. Results: The findings for the four focus areas are as follows: 1) Process Improvement:  met the goal of reducing clinician documentation error to 3%; showed improvement in other measures but did not meet goals. 2) Productivity: met goals of increase show rate, Increasing planned discharges by 2% per agency; some agencies met wait time goals. 3) Workforce Development: met 3 of the 4 goals; did not meet reducing staff turnover. 4) Leadership: participants responded very positively to leadership initiatives. Conclusions: Results indicate that many of the initiatives were successful in moving the agency toward the goals. COVID-19 had a major impact on the continuous improvement efforts.