Building New Neighborhoods: How Learning Collaboratives are Promoting Health and Behavioral Health Care Integration and Coordination in the California Safety Net

Individuals with chronic medical conditions and serious mental health and/or substance use disorders experience poorly coordinated services.  This results in siloed treatment.  Care recipients are also rarely supported to be active in their own care and health. The impact is profoundly negative:  poor care access, inefficient services, higher care costs, reduced satisfaction, poor health outcomes, and lower life expectancies.  

The California Institute for Behavioral Health Solutions (CIBHS) supports safety net organizations to make changes to improve the health status of individuals who have complex, co-occurring conditions and require coordinated services.  A key method CIBHS employs is the implementation of learning collaboratives modeled on the Institute for Healthcare Improvement’s Breakthrough Series that use improvement tools to support organizational change. Beginning in 2009, CIBHS has run six successful collaboratives with participation from thirty California counties focused on improving the coordination of behavioral health. 

This session explores the fundamental changes that safety net providers must test on a small scale and then spread to the broader system to ensure care coordination.  Some of the changes include: outreach and engagement; screening for multiple conditions; establishing multiagency communication; creating workflows for coordinated care; promoting self-management; and using clinical information systems.  Data from the collaborative initiatives suggest that effective care coordination requires, at a minimum: engaged leadership, development of clear roles for providers coordinating care, new work flows across multiple providers, and measurement of client outcomes and system processes across multiple provider organizations.