Bridging the gap toward integrated care: A policy recommendation report for HWLA

Issue: In preparation for health care reform in 2014, the Los Angeles County Department of Mental Health (LAC-DMH) has collaborated with the Department of Health Services (DHS) to implement Healthy Way L.A. (HWLA), the first County-wide effort intended to provide the continuum of physical health and mental health services to medically underserved and underrepresented persons within Los Angeles County. Description: The policy paper charts the developmental trajectory of the recovery model and County's transition to the integrated care model. An overview of the mental health client flow mapping process identifies discrete points along the map involving the referral process, care coordination, and programmatic cost implications. In a preliminary needs assessment, a ten-point semi-structured interview guide was used to conduct, record, and analyze twenty LAC-DMH staff qualitative interviews discussing perceived programmatic successes, gaps, and challenges. Lessons Learned: The assessment indicates strong staff commitment, awareness of programmatic challenges, and effective electronic system promoting service integration and delivery. Potential administrative and clinical issues include overcrowding in clinics, overextended waiting times, and diminished quality of care due to unclear roles, resources, and accountability structure. Recommendations: Future policies are recommended to address cultural competency issues to reduce mental health stigma among minority populations, process evaluation techniques including consumer satisfaction measures, clarification of staff roles and objectives, and additional time resources needed for strategic development. Recommendations have been provided to support complex and integrated efforts such as HWLA towards the inclusion of behavioral health services in primary care services as a seamless system of care.