“It Takes Working Together” A study of LA County collaborations and

partnerships in COD treatment

6th Annual COD Conference February 7, 2008

Peter Mendel, PhD Peter Mendel, PhD RANDRAND

Susan Stockdale,PhD Susan Stockdale,PhD UCLAUCLA

Jim Gilmore, MBA Jim Gilmore, MBA BHS Inc.BHS Inc.

The Health Care for Communities Partnership Initiative

Partnering – the HopePartnering – the Hope

“… We want to have an ongoing collaborative partnership meeting so that people, on a regular basis, in our community, come together. We want to be central to making that happen, among quality providers…so that… services are more seamless to the client…they come in one door, and they can be attached to…all these services…whatever it might be, that they need." (Child mental health provider)

“…a lot of these kids have extensive amount of issues-it’d be nice if you can go from one place and then-having all the contacts and say, okay, I came here and maybe they didn’t have all the services I needed, but they have a collaboration with this organization who can turn around and meet those needs.” (Substance abuse agency)

Partnering – the GoodPartnering – the GoodBuilding “true partnerships”…

"We know each other. We tried to go for a grant together. We didn't get it, but we got to know each other's programs, and gain respect for each other, and I think are in that process of making a true partnership. Once again, we have to be very, very clear of what this partnership is going to look like. It's not just referrals. We're talking about doing a mutual project where families can benefit on both ends. And, that means becoming creative." (Child and family service agency)

Mixed optimism…"I have a sort of general feeling that substance abuse services may have improved a bit over the time I've been at [this agency]. We certainly found more people to liaise with, and a number of them successfully. Whereas, for mental health, really, we seem to be pretty much on our own. There's not too much we can get from anyone else.” (HIV services)

It’s not always rocket science…"…it's really local, like a few blocks away from the center. So in terms of the services, a lot of the families, they look for places in the area. So obviously, that's why we…work with them." (Family services agency)

Partnering – the BadPartnering – the BadSeparate worlds…“…I think it’s because with separate funding sources and separate bureaucracies, they think very differently and it makes it extremely difficult to partner." (Child mental health agency)

“…a lot of times the ways that substance abuse is approached…and mental health is approached…are real different, and it does take a lot of work to allow for both ends. On one end, the focus is on behavior and limit-setting. And on the other the focus is on symptom-management and much more incremental steps." (Drug treatment agency)

Lack of capable partners…“…the organizations either don’t exist or aren’t well-funded…" (HIV services)

Mismatch between services and needs…“Probably the biggest problem is that most substance abuse programs that are designed, which we collaborate with often, do not work well with this population [i.e., chronically mental ill]." (Substance abuse services)

Partnering – the Bad Partnering – the Bad (cont’d)(cont’d)

Overwhelmed system…“I’ve been here ten years. It seems that although there are a lot of agencies, the need seems to be overwhelming the system." (Youth social services agency)

Overwhelmed providers…"I think for individual clinicians and professionals, they’re so overwhelmed with what they’re doing in terms of providing client services…and so many little management demands…, it’s very difficult to include collaboration and partnership building." (Mental health provider)

Unproductive competition…“…unless you change that logic where we all individually go compete…we’re talking about a community feel, and it isn’t going to happen if we continually compete for dollars and I set up my perfect little system." (Homeless services agency)

Partnering – the Bad Partnering – the Bad (and on, and on…)(and on, and on…)

Too much effort…“…basically I had to get out of it because it just wasn’t enough for all the effort and time and energy that was required to actually make it work. All the meetings you had to go to keep the communication lines open and figure out how to work between all the different systems…" (Drug treatment agency)

Missing resources for collaboration…“I think collaboration would be enhanced in our community if we would pay for the collaborations that we do. A lot of times, people want you to collaborate, but they don’t pay you for it..." (Social services provider)

Collaborations on paper…“A lot of partners, and we’re guilty of this, too, sometimes it’s collaboration on paper, or referrals back and forth. It’s not collaboration in the sense of let’s work out this problem together, let’s do this project together, let’s see how we communicate better." (Social service agency)

Partnering – the UglyPartnering – the Ugly

Pessimism…"All that stuff the government has set up where they want all these lead agencies, and all these partner agencies, and everything that's being done is really poorly conceptualized, and doesn't work well. What ends up happening is the lead agency basically takes over the service, and everyone else can't make any money out of it…" (Drug treatment agency)

Lack of interest…

"I don't think it's important to either organization. When I have tried to do stuff with drug and alcohol programs, they're basically not interested. And when I have tried to get community health services to do more for substance abuse, they basically give it lip service…" (Medical care clinic)

Project BackgroundProject Background

Pilot projectPilot project

Funded by Robert Wood Johnson Foundation Funded by Robert Wood Johnson Foundation (RWJF), additional NIMH/NIH(RWJF), additional NIMH/NIH

Community-partnered research projectCommunity-partnered research project– UCLA/RAND NIMH Center, BHS Inc., Healthy African UCLA/RAND NIMH Center, BHS Inc., Healthy African

American Families, LA County DMH, & QueensCare American Families, LA County DMH, & QueensCare Health and Faith PartnershipHealth and Faith Partnership

Data collection from Dec 2005–June 2006Data collection from Dec 2005–June 2006

Community Feedback Conference July 2007Community Feedback Conference July 2007

Research ObjectivesResearch Objectives

Collaboratively understand and measure Collaboratively understand and measure community capacity to partner around mental community capacity to partner around mental health and substance abuse needs health and substance abuse needs – strengths, gaps, common interests and challengesstrengths, gaps, common interests and challenges

Map out current inter-agency partnerships and Map out current inter-agency partnerships and collaborative experiencescollaborative experiences

Explore how organizations can better work Explore how organizations can better work together to achieve community health goals together to achieve community health goals

Intended ImpactIntended Impact

Feed back information to community, enable a Feed back information to community, enable a “community-wide perspective”“community-wide perspective”

Identify opportunities for partneringIdentify opportunities for partnering

Inform the design of community-based Inform the design of community-based partnerships and health interventionspartnerships and health interventions

Track changes in capacities of community Track changes in capacities of community agencies and health partnerships over time agencies and health partnerships over time

Focus of Today’s PresentationFocus of Today’s Presentation

Study resultsStudy results– Agency health prioritiesAgency health priorities

– Inter-agency partnershipsInter-agency partnerships

Community conference feedbackCommunity conference feedback– Implications for “effective” partnering Implications for “effective” partnering

Next stepsNext steps– Your thoughts, reactions, commentsYour thoughts, reactions, comments

– Potential initiatives and brainstormingPotential initiatives and brainstorming

General health priorities are similar across SPA General health priorities are similar across SPA areas, COD is lowest.areas, COD is lowest.

Average number of $ points out of $1000*

Overall(n=61)

SPA 4(n=30)

SPA 6(n=26)

Other(n=5)

Mental health $389 $395 $367 $458

Substance abuse $229 $220 $234 $254

COD $150 $188 $113 $106

Physical health $233 $197 $286 $182

$1000 $1000 $1000 $1000

* Priorities bolded if average $ points were greater than or equal to $200.

COD doesn’t come out too bad if look at COD doesn’t come out too bad if look at individual health conditions.individual health conditions.

Average number of $ points out of $1000

Overall(n=61)

SPA 4(n=30)

SPA 6(n=26)

Other(n=5)

Mental health*

SMI ($118)Depression ($106)

Anxiety ($38)Personality ($28)Suicidality ($19)

SMI ($141)Depression ($115)

Anxiety ($47)Personality ($25)Suicidality ($8)

SMI ($113)Depression ($109)Personality ($36)

Anxiety ($33)Suicidality ($29)

Depression ($38)Suicidality ($32)

Anxiety ($10)SMI ($2)

Personality ($7)

Substance abuse*

Meth ($57)Cocaine/Crack ($57)

Alcohol ($53)IDU ($16)

Marijuana ($9)

Meth ($101)Alcohol ($38)

Cocaine/Crack ($33)IDU ($17)

Marijuana ($7)

Cocaine/Crack ($91)Alcohol ($75)

Meth ($12)Marijuana ($12)

IDU ($6)

IDU ($57)Alcohol ($37)

Cocaine/Crack ($32)Meth ($20)

Marijuana ($9)

COD COD ($150) COD ($188) COD ($113) COD ($106)

Physical health**

HIV/AIDS ($55)Primary Med ($32)

Hep C ($24)Oral Health ($21)

Obesity ($17)Hypertension ($17)

Diabetes ($14)Tuberculosis ($11)

HIV/AIDS ($70)Primary Med ($42)

Hep C ($26)Oral Health ($20)

HIV/AIDS ($46)Hypertension ($36)

Obesity ($32)Diabetes ($24)

Primary Med ($22)Oral Health ($22)

Hep C ($21)Tuberculosis ($16)

Primary Med ($27)Hep C ($25)

Oral Health ($22)Obesity ($12)Hep A/B ($11)HIV/AIDS ($10)

* Priorities bolded if average $ points were greater than or equal to $50.** Priorities bolded if average $ points were greater than or equal to $30. Physical health

priorities not listed if average $ points were less than $10.

Despite our relatively conservative definition, we Despite our relatively conservative definition, we found a rich diversity of partnerships.found a rich diversity of partnerships.

Total # of partnerships across (n=61 sites): Total # of partnerships across (n=61 sites): 314314

Ave # of partnerships per site: Ave # of partnerships per site: 5.25.2 – 6.3 in SPA 6 vs 4.3 in SPA 46.3 in SPA 6 vs 4.3 in SPA 4

Most commonMost common target services/needs target services/needs addressed: addressed:– Social Services (46%) and MH (41%), followed by Social Services (46%) and MH (41%), followed by

Medical Care (28%) and SA (20%)Medical Care (28%) and SA (20%)

Most commonMost common joint activities joint activities of partnerships: of partnerships:– Joint care management (46%), Joint community Joint care management (46%), Joint community

planning/coordination (44%), and Joint education/ planning/coordination (44%), and Joint education/ outreach initiatives (40%)outreach initiatives (40%)

Mental health partnerships were generally more extensive Mental health partnerships were generally more extensive and densely related than those for substance abuse.and densely related than those for substance abuse.

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Substance Abuse Partnerships(all SPAs)

Mental Health Partnerships(all SPAs)

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Mental health

Substance abuse

Social services

Homeless services

Medical services

Main Agency Sector

Criminal Justice

Schools

Other

Unidentified

COD partnerships were the least extensive and most COD partnerships were the least extensive and most fragmented…fragmented…

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Mental health

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Social services

Homeless services

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Main Agency Sector

Criminal Justice

Schools

Other

Unidentified

……even if one includes partnerships involving both MH even if one includes partnerships involving both MH & SA services, but are not identified as COD per se.& SA services, but are not identified as COD per se.

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Mental health

Substance abuse

Social services

Homeless services

Medical services

Criminal Justice

Schools

Other

Unidentified

Main Agency Sector

MH + SA partnerships, but not identified as COD – red linesCOD partnerships – black lines

Community Feedback Conference brought Community Feedback Conference brought together a diverse array of stakeholders to together a diverse array of stakeholders to

discuss implications:discuss implications:

What types of partnerships are most needed?What types of partnerships are most needed?

What are the main challenges in partnering?What are the main challenges in partnering?

What do we need to do to better partner What do we need to do to better partner around MH, SA, & related needs?around MH, SA, & related needs?

What specific types of information would be What specific types of information would be useful to support effective partnering? useful to support effective partnering?

Spirited discussions yielded rich exchange of Spirited discussions yielded rich exchange of

views and insights, with the following highlights:views and insights, with the following highlights:

Focused on how to make progress on different health Focused on how to make progress on different health priorities, root causes and joint solutionspriorities, root causes and joint solutions– Rather than attempting to rank orderRather than attempting to rank order

Partnering is not a panaceaPartnering is not a panacea– Need to work towards Need to work towards effectiveeffective partnering partnering– Eye on the prize: useful objectives of partneringEye on the prize: useful objectives of partnering

A wealth of expertise, knowledge, resources in the A wealth of expertise, knowledge, resources in the communitycommunity– But how to match and connect these “islands” of strengths/capacities But how to match and connect these “islands” of strengths/capacities

to where most useful?to where most useful?

Enthusiasm and energy for effective partneringEnthusiasm and energy for effective partnering– Specific suggestions related to: Community dialogue & Specific suggestions related to: Community dialogue &

engagement, Partnering tools & resources, Partnering engagement, Partnering tools & resources, Partnering research & evaluation activitiesresearch & evaluation activities

Your thoughts, reactions, commentsYour thoughts, reactions, comments

What resonates with your experiences?What resonates with your experiences?

To what degree is partnering the answer to To what degree is partnering the answer to improving COD services in LA County? improving COD services in LA County? – What’s the potential, the limitations?What’s the potential, the limitations?

How can effective collaborations for COD services How can effective collaborations for COD services be enhanced in LA communities?be enhanced in LA communities?

What specific types of collaborative initiatives do What specific types of collaborative initiatives do you think are needed to improve COD services in you think are needed to improve COD services in LA County? LA County? – What are the most important priorities? What are the most important priorities?

– Who needs to be collaborating with whom?Who needs to be collaborating with whom?

Thank You!Thank You!

For copies of reports and more information on the HCC Partnership Initiative:

http://www.hsrcenter.ucla.edu/research/hccpi.shtml