Healthcare for Communities Partnership Initiative

RATIONALE: In spite of the development of evidence-based treatments, many individuals still do not receive the care they need for mental health and substance abuse conditions. One reason for this is that dissemination of evidence-based treatments must travel through many channels before they reach the providers of care and, ultimately, the consumers. One promising new approach to dissemination is through participatory research that uses existing networks of community organizations. However, very little is known about how the capacity of community organizations to partner around specific interventions or programs affects dissemination of evidence-based treatments. The mental health and substance abuse fields, and perhaps the healthcare delivery field in general, now are at a new interface that considers not just levels of unmet need or even documentation of policy gaps, but how to use knowledge and understanding of community contexts and resources to build systems of care that more effectively address mental health and substance abuse needs. This goal goes beyond developing and testing new evidence-based treatment interventions. Rather, the imperative to improve health and healthcare delivery for the general population requires new kinds of information and strategies that focus on partnered approaches to researching and building community capacity.

OBJECTIVE(S): The purpose of this study is to develop a collaborative approach to identify and assess aspects of organizational capacity that are associated with successful community partnerships around improving mental health and substance abuse outcomes. This study combines the two goals of "tracking" community information and developing a collaborative approach because, in the context of communities, tracking and assessment can often be viewed as exploitative or designed solely for the purposes of researchers or the academic establishment, even when implemented in a participatory manner. The specific aims of the study are to: 1) identify the different capacities, strengths, and sets of expertise that local organizations bring to addressing mental health and substance abuse issues in a community; 2) map out current inter-agency partnerships and collaborative experiences around these issues; and 3) explore how organizations can work together to achieve community mental health and substance abuse goals.

METHODS: The main method for collecting data for the study consisted of an in-person, semi-structured interview of about an hour in length with administrative staff from a variety of service agencies and community-based organizations serving people with mental health and/or substance abuse needs in two Los Angeles County Service Provision Areas (SPAs): Hollywood Metro/Downtown (SPA 4) and South LA (SPA 6). These two SPA areas each include large and diverse communities representing high need for public health and mental health services, but also exhibiting unique sets of community stakeholders, service providers, and different histories of community collaborations. The sample of agencies was compiled through a polling and rating process with a panel of knowledgeable community experts and included a number of social service, medical care, and other types of agencies in addition to those in the mental health and substance abuse treatment sectors. In all, interviews were conducted with 67 agencies (a response rate of 71% in SPA 4 and 77% in SPA 6).

STATUS: Preliminary findings from the study interviews were compiled into a chart book, which included information on the community health priorities of agencies related to mental health, substance abuse, and medical care needs; the existing composition and structure of inter-agency partnership networks for different services in each SPA area; and partnering successes, barriers, and desired future types of partnerships reported by the individuals interviewed at agencies that participated in the study. These results were also presented at the Community Feedback Conference held at the USC Davidson Conference Center in July 2006, which was attended by over 80 individuals representing 50 organizations in Los Angeles. The content and conclusions of the conference discussions were summarized in a separate Community Feedback Report.

IMPACT: The intended impact of the project is to feed back information to study participants and other interested stakeholders in Los Angeles communities in order to help 1) identify opportunities for partnering among local organizations; 2) inform the design and implementation of community-based partnerships and health interventions; and 3) track changes in the capacity of communities and local health partnerships over time to address mental health and substance abuse needs and disparities. The results of the study have been fed back to study participants and other interested stakeholders in Los Angeles communities through local distribution of study reports in Los Angeles and via the Community Feedback Conference. The conference in particular generated a great deal of discussion and insight around partnering related to mental health and substance abuse needs as well as served as an opportunity for community agencies and groups to network with each other around mutual interests and challenges faced by organizations serving individuals with mental health and/or substance abuse disorders. The data are also currently being used in planning follow-up projects, and further analyses are ongoing.