{"edition":"los-angeles","organization":"Sycamores","organizationId":"org:sycamores","boundaryVersion":"OMB-23-01-2023-07-21","updated":"2026-09-14","model":{"version":"la-sycamores-dominant-clinical-v1","costScope":"Full recipient resources; priced health is a dominant-clinical component, not entire portfolio.","geographicAttribution":"g=.9 is a clinical residence prior excluding Riverside; not an observed share and not applied to nationwide training.","formula":"Q_component=(D*e/u)*q*t*b*g/(1+d). D=40872560,e=.5,u=10000,q=.022,t=.5,b=.25,g=.9,d=.03 gives Q=4.91065951456; Price10=10*69182014/Q. Q_portfolio=Q_component+Q_other-H; unpriced Q_other remains unknown.","counterfactual":"County-supported alternative therapy and existing capacity continue; funding responsiveness concerns extra recipient resources, not the absence of all services. MICE already compares with enhanced usual care.","attribution":"Use clinical offers once, not all 37000 people reached or every crisis encounter. No multiplication by the separate MATCH improvement rate, session count or completion probability. Caregiver effects appear only in a separately labeled sensitivity.","uncertainty":"Conditional component best estimate with subjective delivery and transfer priors; not a complete portfolio estimate or statistical interval. Zero and adverse outcomes are possible.","nativeOutcomes":"D*e/u=2043.628 compatible offer-equivalents; after transfer and funding, 255.4535 reference-effect-equivalent offers; geography and timing yield 4.91066 LA QALYs. Counts are modeled expectations, not observed marginal patients.","inputs":[{"name":"C","value":69182014,"unit":"USD full annual recipient resources","basis":"observed","rationale":"Part IX plus event costs.","sourceIds":["99025"]},{"name":"D","value":40872560,"unit":"USD community/clinic service expense","basis":"observed","rationale":"Largest Part III service line; used only to model delivery, not the cost denominator.","sourceIds":["99025"]},{"name":"e","value":0.5,"unit":"compatible clinical budget share","basis":"judgment","rationale":"Half of the service line is assumed suitable for a modular youth-treatment offer; test .2–.8.","sourceIds":["clinical","match"]},{"name":"u","value":10000,"unit":"USD clinical service-line resources per compatible offer","basis":"judgment","rationale":"Conservative planning prior, not an observed unit cost; test 5000–20000. Includes clinical direct and support activity within D.","sourceIds":["clinical","99025"]},{"name":"q","value":0.022,"unit":"additional child QALY per randomized offer over 12 months","basis":"observed","rationale":"Rounded MICE Table 3 child estimate, not combined caregiver QALYs or per completed session.","sourceIds":["mice","mice-original"]},{"name":"t","value":0.5,"unit":"effect transfer","basis":"judgment","rationale":"Different clinical population and modern alternative care; test .1–1.","sourceIds":["match","mice"]},{"name":"b","value":0.25,"unit":"proportional funding responsiveness","basis":"judgment","rationale":"Capacity change after public and donor substitution; test .05–.75.","sourceIds":["99025","capital"]},{"name":"g","value":0.9,"unit":"LA/Orange resident share of clinical component","basis":"judgment","rationale":"Riverside excluded; residence distribution not observed. Test .7–.98.","sourceIds":["school","crisis"]},{"name":"d","value":0.03,"unit":"one-year delivery discount","basis":"judgment","rationale":"Discounts future annual offer once; q already includes a finite 12-month trajectory.","sourceIds":[]},{"name":"Q_other","value":null,"unit":"additional non-overlapping LA portfolio QALYs","basis":"unknown","rationale":"Residential, housing, crisis and training pathways remain unpriced.","sourceIds":["portfolio"]}],"scenarios":[{"id":"central","label":"Conditional dominant-clinical component","costUSD":69182014,"allPopulationQalys":5.456288349514562,"editionQalys":4.910659514563106,"assumptions":"u,e,q,t,b,g=10000,0.5,0.022,0.5,0.25,0.9; d=.03. Not a whole-portfolio bound."},{"id":"low","label":"Weak delivery and transfer","costUSD":69182014,"allPopulationQalys":0.003968209708737864,"editionQalys":0.0027777467961165045,"assumptions":"u,e,q,t,b,g=20000,0.2,0.002,0.1,0.05,0.7; d=.03. Not a whole-portfolio bound."},{"id":"high","label":"Favorable delivery and transfer","costUSD":69182014,"allPopulationQalys":209.52147262135918,"editionQalys":205.33104316893198,"assumptions":"u,e,q,t,b,g=5000,0.8,0.044,1,0.75,0.98; d=.03. Not a whole-portfolio bound."},{"id":"family","label":"Child plus caregiver component sensitivity","costUSD":69182014,"allPopulationQalys":22.321179611650482,"editionQalys":20.089061650485434,"assumptions":"u,e,q,t,b,g=10000,0.5,0.09,0.5,0.25,0.9; d=.03. Uses .090 combined child/caregiver QALY; verify caregiver residence and avoid overlap."},{"id":"portfolio-unknown","label":"Whole-portfolio return unestimated","costUSD":69182014,"allPopulationQalys":null,"editionQalys":null,"assumptions":"Other pathways cannot be treated as zero for ranking."},{"id":"zero","label":"Complete replacement or no component benefit","costUSD":69182014,"allPopulationQalys":0,"editionQalys":0,"assumptions":"b=0 or t=0."},{"id":"adverse","label":"Illustrative net component harm","costUSD":69182014,"allPopulationQalys":-1,"editionQalys":-1,"assumptions":"One LA QALY lost is a stress test, not observed harm."}],"sensitivity":["Central component $140881308.91/10; favorable $3369291.51; weak $249058028243.33; family $34437653.29.","Required whole-portfolio LA health at $1m/10 is 691.82014 QALYs; at $100k/10 is 6918.2014.","Halving compatible budget share, funding responsiveness or transfer doubles positive price; doubling cost per offer also doubles it.","q is finite 12-month health area; no lifetime extension. Clinic recipients and caregivers may overlap with housing and crisis pathways."],"missingInputs":["Observed compatible course costs and unique annual offers.","Current marginal funding gap and reimbursement substitution.","LA/Orange residence and clinical case mix.","Local causal utility outcomes and non-overlapping residential, housing and crisis effects."]},"sources":[{"id":"99025","title":"FY2025 Form 990, filed May 4, 2026","url":"https://projects.propublica.org/nonprofits/full_text/202631249349302098/IRS990","publisher":"Sycamores / IRS","published":"2026-05-04","retrieved":"2026-09-14"},{"id":"99024","title":"FY2024 Form 990","url":"https://projects.propublica.org/nonprofits/full_text/202531329349304133/IRS990","publisher":"Sycamores / IRS","published":"2025-05-12","retrieved":"2026-09-14"},{"id":"99023","title":"FY2023 Form 990","url":"https://projects.propublica.org/nonprofits/full_text/202411369349302771/IRS990","publisher":"Sycamores / IRS","published":"2024-05-15","retrieved":"2026-09-14"},{"id":"schedule25","title":"FY2025 expense reconciliation","url":"https://projects.propublica.org/nonprofits/full_text/202631249349302098/IRS990ScheduleD","publisher":"Sycamores / IRS","published":null,"retrieved":"2026-09-14"},{"id":"schedule24","title":"FY2024 expense reconciliation","url":"https://projects.propublica.org/nonprofits/full_text/202531329349304133/IRS990ScheduleD","publisher":"Sycamores / IRS","published":null,"retrieved":"2026-09-14"},{"id":"schedule23","title":"FY2023 expense reconciliation","url":"https://projects.propublica.org/nonprofits/full_text/202411369349302771/IRS990ScheduleD","publisher":"Sycamores / IRS","published":null,"retrieved":"2026-09-14"},{"id":"home","title":"Current recipient reach","url":"https://www.sycamores.org/","publisher":"Sycamores","published":null,"retrieved":"2026-09-14"},{"id":"clinical","title":"Behavioral health services","url":"https://www.sycamores.org/behavioral-health/","publisher":"Sycamores","published":null,"retrieved":"2026-09-14"},{"id":"school","title":"School services and reported outcomes","url":"https://www.sycamores.org/education-based-services/","publisher":"Sycamores","published":null,"retrieved":"2026-09-14"},{"id":"crisis","title":"Mobile crisis and CIRCLE geography","url":"https://www.sycamores.org/mobile-crisis-outreach-team/","publisher":"Sycamores","published":null,"retrieved":"2026-09-14"},{"id":"housing","title":"Housing support","url":"https://www.sycamores.org/homeless-housing-support/","publisher":"Sycamores","published":null,"retrieved":"2026-09-14"},{"id":"match","title":"California randomized modular treatment comparison","url":"https://pubmed.ncbi.nlm.nih.gov/27548030/","publisher":"Chorpita and colleagues / JCCP","published":"2016-08-22","retrieved":"2026-09-14"},{"id":"benchmark","title":"Practical MATCH implementation benchmarking","url":"https://pubmed.ncbi.nlm.nih.gov/37091107/","publisher":"MATCH investigators","published":null,"retrieved":"2026-09-14"},{"id":"mice","title":"MICE randomized economic evaluation; Table 3 visually verified","url":"https://doi.org/10.1192/bjo.2025.10916","publisher":"Ganguli and colleagues / BJPsych Open","published":null,"retrieved":"2026-09-14"},{"id":"mice-original","title":"Repository original MICE economic article","url":"https://api.repository.cam.ac.uk/server/api/core/bitstreams/3a9adca4-0ec1-45c9-ac27-47ae75a3f35d/content","publisher":"University of Cambridge","published":null,"retrieved":"2026-09-14"},{"id":"capital","title":"Publicly funded Altadena crisis capacity","url":"https://www.dhcs.ca.gov/news/california-to-expand-behavioral-health-care-in-los-angeles-county/","publisher":"California DHCS","published":"2025-05-16","retrieved":"2026-09-14"},{"id":"portfolio","title":"Current service portfolio","url":"https://www.sycamores.org/services/","publisher":"Sycamores","published":null,"retrieved":"2026-09-14"}]}