{"edition":"los-angeles","organization":"Didi Hirsch Mental Health Services","organizationId":"ein:95-1816023","boundaryVersion":"OMB-23-01-2023-07-21","updated":"2026-09-14","model":{"version":"la-didi-depression-component-v1","costScope":"Full annual recipient recognized resources, including donated services and restored event costs. The health numerator is only a depression-treatment component, not the complete portfolio. No program-only denominator or public-contract subtraction.","geographicAttribution":"g=.95 is a judgment for clinical outpatient residents in Los Angeles and Orange Counties, supported by local sites but not observed patient residence. Do not apply it to national 988, Teen Line or other remote activity.","formula":"Q_component_LA = N*s*p*e*q*t*b*g/(1+d)-H. N=5498 annual outpatient clients; s=.6 adult-compatible share; p=.32 depression share; e=.5 clinical offer eligibility; q=.057 external 12-month intention-to-treat QALY effect; t=.5 clinical transfer; b=.25 proportional funding responsiveness; g=.95 LA residence; d=.03 next-year delivery discount; H=0 in the conditional positive case. Q=3.46854407767. Price10=10*C/Q, C=80043834. Complete portfolio Q = Q_component_LA + Q_other_LA; Q_other_LA remains unknown, not zero.","counterfactual":"Usual medication and clinical care continue; public contracts, alternative providers and reserves replace some capacity. CoBalT already compares with usual care, so no extra generic usual-care discount is applied. b only concerns whether added recipient funding changes clinical capacity.","attribution":"The clinical transfer t covers differences in delivered therapy, setting and case mix after eligibility e. No separate coalition multiplier is added. Count each client once in this component, and do not add overlapping symptom gains from crisis or substance-use services. q is per offer, so trial noncompletion must not be discounted a second time.","uncertainty":"This is a conditional component illustration, not an expected whole-portfolio return, lower bound or confidence interval. Adult share, eligibility, transfer, funding and residence are explicit subjective inputs. Major other pathways are unpriced; zero or adverse net effect is possible.","nativeOutcomes":"5498 outpatient clients -> 3298.8 adult-compatible client-equivalents -> 1055.616 depression client-equivalents -> 527.808 eligible offers -> 65.976 reference-effect-equivalent offers after transfer and funding -> 3.46854 discounted LA QALYs. These are model expectations, not observed additional patients or completions.","inputs":[{"name":"C","value":80043834,"unit":"USD annual full recognized recipient resources","basis":"observed","rationale":"FY2025 Part IX 79,340,574 + donated services 482,866 + event costs 220,394.","sourceIds":["99025","schedule25"]},{"name":"N","value":5498,"unit":"reported annual outpatient clients","basis":"observed","rationale":"2025 annual report, printed page 9; not crisis contacts.","sourceIds":["annual25"]},{"name":"s","value":0.6,"unit":"adult-compatible share of outpatient total","basis":"judgment","rationale":"Adult denominator not separately supplied. .6 central, .3–.8 joint stress tests; not an observed age distribution.","sourceIds":["annual25"]},{"name":"p","value":0.32,"unit":"depression diagnosis share","basis":"observed","rationale":"Reported in adult outpatient narrative; transport to eligible count conditional on s.","sourceIds":["annual25"]},{"name":"e","value":0.5,"unit":"eligible depression-treatment offer fraction","basis":"judgment","rationale":"Excludes clients unlike CoBalT, including major psychosis/bipolar/substance-use overlap and already-equivalent therapy; test .1–.8.","sourceIds":["cobalt"]},{"name":"q","value":0.057,"unit":"additional QALYs per randomized CBT offer over 12 months","basis":"observed","rationale":"External CoBalT intention-to-treat estimate; not per completed course or per year indefinitely.","sourceIds":["cobalt-economic"]},{"name":"t","value":0.5,"unit":"clinical effect transfer fraction","basis":"judgment","rationale":"Different intensity and clinical system; .1–1 joint tests. Not a local empirical rate.","sourceIds":["treatment","cobalt"]},{"name":"b","value":0.25,"unit":"proportional funding responsiveness","basis":"judgment","rationale":"New ordinary support changes one-quarter of proportional clinical delivery after replacement funding; .05–.75 stress tests.","sourceIds":["99025","case-support"]},{"name":"g","value":0.95,"unit":"LA+Orange resident share of modeled clinical component","basis":"judgment","rationale":"Local sites support concentration; residence not observed. .8–1 stress tests.","sourceIds":["locations"]},{"name":"d","value":0.03,"unit":"one-year delivery discount","basis":"judgment","rationale":"q already measures one-year health area; discount once for future delivery, not again for duration.","sourceIds":[]},{"name":"H","value":0,"unit":"component harm QALYs in positive illustration","basis":"judgment","rationale":"Zero only in positive illustrative scenarios; negative stress test retained.","sourceIds":[]},{"name":"Q_other_LA","value":null,"unit":"additional non-overlapping LA portfolio QALYs","basis":"unknown","rationale":"988, severe mental illness, youth, residential and substance-use benefits and harms require separate models.","sourceIds":[]}],"scenarios":[{"id":"central","label":"Conditional depression component, not whole portfolio","costUSD":80043834,"allPopulationQalys":3.6510990291262138,"editionQalys":3.468544077669903,"assumptions":"N=5498,s=.6,p=.32,e=.5,q=.057,t=.5,b=.25,g=.95,d=.03,H=0. A continuation-scale proportional funding model, not a claim that all existing patients depend on a new gift."},{"id":"low","label":"Weak component delivery and funding response","costUSD":80043834,"allPopulationQalys":0.014604396116504853,"editionQalys":0.011683516893203884,"assumptions":"s=.3,e=.1,t=.1,b=.05,g=.8; other positive-case inputs unchanged."},{"id":"high","label":"Favorable component assumptions","costUSD":80043834,"allPopulationQalys":46.73406757281555,"editionQalys":46.73406757281555,"assumptions":"s=.8,e=.8,t=1,b=.75,g=1; not a confidence bound."},{"id":"gross-form990-cost","label":"Component excluding donated-service valuation","costUSD":79560968,"allPopulationQalys":3.6510990291262138,"editionQalys":3.468544077669903,"assumptions":"Same clinical assumptions; use gross Form 990 accrual expense, not cash flows."},{"id":"zero","label":"No additional component health","costUSD":80043834,"allPopulationQalys":0,"editionQalys":0,"assumptions":"b=0 or t=0,H=0; other portfolio value is not implied zero."},{"id":"adverse","label":"Illustrative adverse component","costUSD":80043834,"allPopulationQalys":-1,"editionQalys":-1,"assumptions":"No benefit and H=1 LA QALY; magnitude is a stress test, not an empirical harm estimate."},{"id":"portfolio-unknown","label":"Whole-portfolio health remains unestimated","costUSD":80043834,"allPopulationQalys":null,"editionQalys":null,"assumptions":"Q_other_LA is unknown; do not substitute the component price for a full-recipient ranking."}],"sensitivity":["Central component price is $230,770,698.62 per 10 LA QALYs; favorable $17,127,512.79; weak $68,510,051,152.97. Joint cases are subjective stress tests.","At the full-recipient $1 million/10 target, required annual LA health is 800.43834 QALYs; $100,000/10 requires 8004.3834.","Halving the adult share, clinical eligibility, transfer or funding responsiveness doubles the positive component price.","The 0.057 QALY includes the trial's entire 12-month utility trajectory. No lifetime extrapolation, per-session multiplier or duplicated completion discount is applied.","Applying the depression effect to schizophrenia, bipolar disorder, all children or crisis callers would materially overstate the evidence.","Other portfolio value may dominate the depression component; omission is not proof of low overall effectiveness."],"missingInputs":["Unique adult depression denominator and clinical eligibility, including existing psychotherapy and comorbidity.","Delivered treatment intensity, local utility trajectories and causal comparison with current alternatives.","Current unrestricted funding gap after the June 2026 fundraising deadline and public renewals.","Patient residence and outcome overlap across clinics, crisis services and substance-use treatment.","Independent cost-to-clinical-outcome models for the unpriced majority of services."]},"sources":[{"id":"annual25","title":"2025 Annual Report, including current services and financial summary","url":"https://didihirsch.org/wp-content/uploads/2026/07/2025-Annual-Report.pdf","publisher":"Didi Hirsch","published":null,"retrieved":"2026-09-13"},{"id":"99025","title":"Original Form 990 for fiscal year ending June 2025","url":"https://projects.propublica.org/nonprofits/organizations/951816023/202610899349301251/full","publisher":"Didi Hirsch / IRS via ProPublica","published":"2026-03-30","retrieved":"2026-09-13"},{"id":"99024","title":"Original Form 990 for fiscal year ending June 2024 with 2023 comparative totals","url":"https://projects.propublica.org/nonprofits/organizations/951816023/202520839349300422/full","publisher":"Didi Hirsch / IRS via ProPublica","published":"2025-03-24","retrieved":"2026-09-13"},{"id":"efp","title":"Qualitative evaluation of UCLA–Didi Hirsch post-discharge follow-up partnership","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC10655296/","publisher":"Soderlund et al., BMC Health Services Research","published":"2023-11-17","retrieved":"2026-09-13"},{"id":"sosa","title":"Open-label evaluation of Survivors of Suicide Attempts groups","url":"https://pubmed.ncbi.nlm.nih.gov/30080086/","publisher":"Hom et al., Psychological Services","published":null,"retrieved":"2026-09-13"},{"id":"edsafe","title":"ED-SAFE sequential-phase suicide prevention trial","url":"https://pubmed.ncbi.nlm.nih.gov/28456130/","publisher":"Miller et al., JAMA Psychiatry","published":"2017-06-01","retrieved":"2026-09-13"},{"id":"99023","title":"Original FY2023 Form 990 and Schedule D","url":"https://projects.propublica.org/nonprofits/organizations/951816023/202431369349311023/full","publisher":"Didi Hirsch / IRS via ProPublica","published":"2024-05-15","retrieved":"2026-09-14"},{"id":"schedule25","title":"Original FY2025 Schedule D expense reconciliation","url":"https://projects.propublica.org/nonprofits/full_text/202610899349301251/IRS990ScheduleD","publisher":"Didi Hirsch / IRS via ProPublica","published":"2026-03-30","retrieved":"2026-09-14"},{"id":"schedule24","title":"Original FY2024 Schedule D expense reconciliation","url":"https://projects.propublica.org/nonprofits/full_text/202520839349300422/IRS990ScheduleD","publisher":"Didi Hirsch / IRS via ProPublica","published":"2025-03-24","retrieved":"2026-09-14"},{"id":"schedule23","title":"Original FY2023 Schedule D expense reconciliation","url":"https://projects.propublica.org/nonprofits/full_text/202431369349311023/IRS990ScheduleD","publisher":"Didi Hirsch / IRS via ProPublica","published":"2024-05-15","retrieved":"2026-09-14"},{"id":"treatment","title":"Current treatment portfolio","url":"https://didihirsch.org/treatment/mental-health/","publisher":"Didi Hirsch","published":null,"retrieved":"2026-09-14"},{"id":"locations","title":"Current clinic geography","url":"https://didihirsch.org/locations/","publisher":"Didi Hirsch","published":null,"retrieved":"2026-09-14"},{"id":"cobalt","title":"CoBalT original randomized trial","url":"https://pubmed.ncbi.nlm.nih.gov/24824481/","publisher":"Wiles et al.; NIHR Health Technology Assessment","published":null,"retrieved":"2026-09-14"},{"id":"cobalt-economic","title":"CoBalT economic evaluation methods and results","url":"https://www.ncbi.nlm.nih.gov/books/NBK261987/","publisher":"Wiles et al.; NIHR Journals Library","published":null,"retrieved":"2026-09-14"},{"id":"case-support","title":"Case for support; internal date August 8, 2025","url":"https://didihirsch.org/wp-content/uploads/2026/07/Didi-Hirsch-Case-for-Support.pdf","publisher":"Didi Hirsch","published":null,"retrieved":"2026-09-14"},{"id":"internship","title":"2026–27 clinical internship handbook","url":"https://didihirsch.org/wp-content/uploads/2025/09/2024-07-Doctoral-Internship-Word-08.26.25.pdf","publisher":"Didi Hirsch","published":null,"retrieved":"2026-09-14"}]}