Peter Mendel, PhD RAND Susan Stockdale,PhD UCLA Jim Gilmore, MBA BHS Inc.

1. “It Takes Working Together” A study of LA County collaborations and partnerships in COD treatment The Health Care for Communities Partnership Initiative Peter Mendel, PhD RAND Susan Stockdale,PhD UCLA Jim Gilmore, MBA BHS Inc. 6th Annual COD Conference February 7, 2008

2. Partnering – 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)

3. Partnering – the Good Building “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 anyoneelse.” (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)

4. Partnering – the Bad Separate 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)

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

6. Partnering – the Bad (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)

7. Partnering – 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)

8. Project Background • Pilot project • Funded by Robert Wood Johnson Foundation (RWJF), additional NIMH/NIH • Community-partnered research project • UCLA/RAND NIMH Center, BHS Inc., Healthy African American Families, LA County DMH, & QueensCare Health and Faith Partnership • Data collection from Dec 2005–June 2006 • Community Feedback Conference July 2007

9. Research Objectives • Collaboratively understand and measure community capacity to partner around mental health and substance abuse needs • strengths, gaps, common interests and challenges • Map out current inter-agency partnerships and collaborative experiences • Explore how organizations can better work together to achieve community health goals

10. Intended Impact • Feed back information to community, enable a “community-wide perspective” • Identify opportunities for partnering • Inform the design of community-based partnerships and health interventions • Track changes in capacities of community agencies and health partnerships over time

11. Focus of Today’s Presentation • Study results • Agency health priorities • Inter-agency partnerships • Community conference feedback • Implications for “effective” partnering • Next steps • Your thoughts, reactions, comments • Potential initiatives and brainstorming

12. General health priorities are similar across SPA areas, COD is lowest. * Priorities bolded if average $ points were greater than or equal to $200.

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

14. Despite our relatively conservative definition, we found a rich diversity of partnerships. • Total # of partnerships across (n=61 sites): 314 • Ave # of partnerships per site: 5.2 • 6.3 in SPA 6 vs 4.3 in SPA 4 • Most common target services/needs addressed: • Social Services (46%) and MH (41%), followed by Medical Care (28%) and SA (20%) • Most common joint activities of partnerships: • Joint care management (46%), Joint community planning/coordination (44%), and Joint education/ outreach initiatives (40%)

15. Main Agency Sector Mental health Substance abuse Social services Homeless services Medical services Criminal Justice Schools Other Unidentified Mental health partnerships were generally more extensive and densely related than those for substance abuse. Mental Health Partnerships (all SPAs) Substance Abuse Partnerships (all SPAs)

16. 61051 61241 41185 61031 61011 102361 51941 61322 61272 Main Agency Sector Mental health Substance abuse Social services Homeless services Medical services Criminal Justice Schools Other Unidentified 101832 41321 71811 COD partnerships were the least extensive and most fragmented…

17. 101093 41082 61081 62401 102361 61281 62362 101524 51941 61322 61341 61272 101832 61011 41261 61123 61331 62681 61021 61202 61201 61171 61731 Main Agency Sector 101441 41185 Mental health Substance abuse Social services Homeless services Medical services Criminal Justice Schools Other Unidentified 61241 61051 41121 41021 61031 41321 41281 71811 43221 41104 …even if one includes partnerships involving both MH & SA services, but are not identified as COD per se. MH + SA partnerships, but not identified as COD – red lines COD partnerships – black lines

18. Community Feedback Conference brought together a diverse array of stakeholders to discuss implications: • What types of partnerships are most needed? • What are the main challenges in partnering? • What do we need to do to better partner around MH, SA, & related needs? • What specific types of information would be useful to support effective partnering?

19. Spirited discussions yielded rich exchange of views and insights, with the following highlights: • Focused on how to make progress on different health priorities, root causes and joint solutions • Rather than attempting to rank order • Partnering is not a panacea • Need to work towards effective partnering • Eye on the prize: useful objectives of partnering • A wealth of expertise, knowledge, resources in the community • But how to match and connect these “islands” of strengths/capacities to where most useful? • Enthusiasm and energy for effective partnering • Specific suggestions related to: Community dialogue & engagement, Partnering tools & resources, Partnering research & evaluation activities

20. Your thoughts, reactions, comments • What resonates with your experiences? • To what degree is partnering the answer to improving COD services in LA County? • What’s the potential, the limitations? • How can effective collaborations for COD services be enhanced in LA communities? • What specific types of collaborative initiatives do you think are needed to improve COD services in LA County? • What are the most important priorities? • Who needs to be collaborating with whom?

21. Thank You! For copies of reports and more information on the HCC Partnership Initiative: http://www.hsrcenter.ucla.edu/research/hccpi.shtml