Community Partnering for Behavioral Health Equity: Public Agency and Community Leaders' Views of its Promise and Challenge

Elizabeth Bromley; Chantal Figueroa; Enrico G Castillo; Farbod Kadkhoda; Bowen Chung; Jeanne Miranda; Kumar Menon; Yolanda Whittington; Felica Jones; Kenneth B Wells; Sheryl H Kataoka

doi:10.18865/ed.28.S2.397

Community Partnering for Behavioral Health Equity: Public Agency and Community Leaders' Views of its Promise and Challenge

Ethn Dis. 2018 Sep 6;28(Suppl 2):397-406. doi: 10.18865/ed.28.S2.397. eCollection 2018.

Authors

Affiliations

¹ Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; Desert Pacific MIRECC Health Services Unit, VA Greater Los Angeles Healthcare System, Los Angeles, CA.
² Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA.
³ University of California, Los Angeles, David Geffen School of Medicine, Los Angeles County Department of Mental Health, Los Angeles, CA.
⁴ Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; RAND Corporation; Los Angeles Biomedical Research Institute; Healthy African American Families II, Los Angeles, CA.
⁵ Los Angeles County Department of Mental Health, Los Angeles, CA.
⁶ Healthy African American Families II, Los Angeles, CA.
⁷ Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; RAND Corporation; University of California, Los Angeles School of Public Health, Los Angeles, CA.
⁸ Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; UCLA Division of Child and Adolescent Psychiatry, Los Angeles, CA.

Abstract

Objective: To understand potential for multi-sector partnerships among community-based organizations and publicly funded health systems to implement health improvement strategies that advance health equity.

Design: Key stakeholder interviewing during HNI planning and early implementation to elicit perceptions of multi-sector partnerships and innovations required for partnerships to achieve system transformation and health equity.

Setting: In 2014, the Los Angeles County (LAC) Board of Supervisors approved the Health Neighborhood Initiative (HNI) that aims to: 1) improve coordination of health services for behavioral health clients across safety-net providers within neighborhoods; and 2) address social determinants of health through community-driven, public agency sponsored partnerships with community-based organizations.

Participants: Twenty-five semi-structured interviews with 49 leaders from LAC health systems, community-based organizations; and payers.

Results: Leaders perceived partnerships within and beyond health systems as transformative in their potential to: improve access, value, and efficiency; align priorities of safety-net systems and communities; and harness the power of communities to impact health. Leaders identified trust as critical to success in partnerships but named lack of time for relationship-building, limitations in service capacity, and questions about sustainability as barriers to trust-building. Leaders described the need for procedural innovations within health systems that would support equitable partnerships including innovations that would increase transparency and normalize information exchange, share agenda-setting and decision-making power with partners, and institutionalize partnering through training and accountability.

Conclusions: Leaders described improving procedural justice in public agencies' relationships with communities as key to effective partnering for health equity.

Keywords: Behavioral Health; Care Coordination; Community Partnering; Health Equity; Procedural Justice.

MeSH terms

Health Equity* / organization & administration
Health Equity* / standards
Health Equity* / trends
Humans
Intersectoral Collaboration
Mental Health / standards
Quality Improvement / organization & administration*
Residence Characteristics
Social Determinants of Health* / standards
Social Determinants of Health* / trends
Social Justice*
United States

Abstract

MeSH terms

Grants and funding