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“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
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)
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 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 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)
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)
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)
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)
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
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
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
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
General health priorities are similar across
SPA areas, COD is lowest.
Average number of $ points out of $1000*
Overall SPA 4 SPA 6 Other
(n=61) (n=30) (n=26) (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
individual health conditions.
Average number of $ points out of $1000
Overall SPA 4 SPA 6 Other
(n=61) (n=30) (n=26) (n=5)
SMI ($118) SMI ($141) SMI ($113) Depression ($38)
Depression ($106) Depression ($115) Depression ($109) Suicidality ($32)
Mental
Anxiety ($38) Anxiety ($47) Personality ($36) Anxiety ($10)
health* Personality ($28) Personality ($25) Anxiety ($33) SMI ($2)
Suicidality ($19) Suicidality ($8) Suicidality ($29) Personality ($7)
Meth ($57) Meth ($101) Cocaine/Crack ($91) IDU ($57)
Cocaine/Crack ($57) Alcohol ($38) Alcohol ($75) Alcohol ($37)
Substance
Alcohol ($53) Cocaine/Crack ($33) Meth ($12) Cocaine/Crack ($32)
abuse* IDU ($16) IDU ($17) Marijuana ($12) Meth ($20)
Marijuana ($9) Marijuana ($7) IDU ($6) Marijuana ($9)
COD COD ($150) COD ($188) COD ($113) COD ($106)
HIV/AIDS ($55) HIV/AIDS ($70) HIV/AIDS ($46) Primary Med ($27)
Primary Med ($32) Primary Med ($42) Hypertension ($36) Hep C ($25)
Hep C ($24) Hep C ($26) Obesity ($32) Oral Health ($22)
Physical Oral Health ($21) Oral Health ($20) Diabetes ($24) Obesity ($12)
Obesity ($17) Primary Med ($22) Hep A/B ($11)
health**
Hypertension ($17) Oral Health ($22) HIV/AIDS ($10)
Diabetes ($14) Hep C ($21)
Tuberculosis ($11) Tuberculosis ($16)
* 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
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%)
Mental health partnerships were generally more extensive
and densely related than those for substance abuse.
Mental Health Partnerships Substance Abuse Partnerships
(all SPAs) (all SPAs)
61761
61123 61731 62681
61051
41082101093 62281
62261 62251 102361 61322
61281 82241 43211 101524
62401 61202
103081 43071 62841 62121 61123
61081 82231 62871 101832
71103
61031 62111
61124 61732 41261
61171 62271 42241 62371
61201 61013 82201 42261 61773 61031
61051 101881
42221 41051 61202
61331 101891 61811 62362 41185 41184 62362 61401
61021 61011 103201 62141 42721 62621 102181
61181
61241 61341 41121 41281 61341
61371 62601 61273
101524 43201 61811
62481 62351 41061 41751 41561 61131
61092 61671 41381 61171
61322 41261 103001 41532 51942
101951 61191 103231
101832 82701
31161 41181 41271 61371
51374 41601
102361 42091 52171 61651 43121
62341 22051 61201 61261
41021 51201 51084
101031 61775 51943 61021 102092 102271
41411 102101 61071 61281
41311 102001
42511 42501 43061 22081 52161
101441 101521 61771 52191 61331
61871
31113 31164 43051 102111 22042 41701 61081
101981 61011
43041 41821
41183 103031 61991 62364
102271 62401
41631 41321 61181 41021 101093
52193 41681 41082
51944 41381
41091 41451 71841
102181 102492 41281
41731 41721 41121
41683 41351 101441
43221
41712 41621 62711 42491 41891
41961 41352 41651 41104
41651 62691 31112
101791
41561 31283 41185
62681 102471
61731 51971 61771
102311 41311 41182
41241 43221 102101
41321
41104
71802
Main Agency Sector
Mental health Criminal Justice
Substance abuse Schools
Social services Other
Homeless services Unidentified
Medical services
COD partnerships were the least extensive and most
fragmented…
61051 41185
61241
61031
61011
102361
61322
51941
61272
101832
41321
71811
Main Agency Sector
Mental health Criminal Justice
Substance abuse Schools
Social services Other
Homeless services Unidentified
Medical services
…even if one includes partnerships involving both MH
& SA services, but are not identified as COD per se.
102361
101093
41082 101524
61081
62681 62401 61322
61281 101832
61011
61731
41261
101441
51941 61331
41021 61021
61272 61201
41185 61241 61051 61123
Main Agency Sector
62362
41321 Mental health
61031
61202 Substance abuse
71811 41121
Social services
61341
Homeless services
43221 Medical services
41104 61171
Criminal Justice
41281
Schools
MH + SA partnerships, but not identified as COD – red lines Other
COD partnerships – black lines Unidentified
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?
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
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?
Thank You!
For copies of reports and more information on the
HCC Partnership Initiative:
http://www.hsrcenter.ucla.edu/research/hccpi.shtml
