Mental health and substance use disorders remain major contributors to morbidity, disability, and preventable mortality in the United States, despite the availability of prevention services, outreach efforts, and evidence-based treatment approaches. These challenges are acutely felt in Monterey County, where elevated psychological distress, persistent inequities in access to care, workforce shortages, and fragmented service systems intersect with significant socioeconomic, linguistic, cultural, and geographic barriers.

Use of a Modified Theory of Change Framework

The study employed a modified Theory of Change (ToC) methodology to structure the interpretation of findings and identify actionable implementation opportunities. This approach supported consensus among stakeholders on where collaborative efforts were most likely to have impact and helped surface practical strategies that could be implemented within existing county and state systems.

The modified ToC approach is consistent with prior evidence demonstrating the value of Theory of Change frameworks for aligning stakeholders, clarifying causal pathways, and improving the feasibility and relevance of complex health interventions[1] and served as an excellent method to evaluate the gaps and challenges within Monterey County for the study.  

Key Study Objectives

1. Identify critical challenges that are not adequately addressed within Monterey County’s current mental health and substance use disorder systems. 
2. Engage Monterey County stakeholders and partners in developing a shared assessment of needs and a common vision for collaboration. 
3. Identify practical opportunities and actionable solutions to inform future planning and system improvement efforts. 

[1] Dr. John Naslund, lead author on this Landscape study was also co-author of the original Theory of Change framework and causal analysis methodology used frequently in health studies within the U.S. and around the world