Convening 3 Summary

Elevating People with Lived Experiences in Care Systems

Elevating people with lived experiences has been identified as a crucial component in care systems. This diversity of perspective is absolutely critical to improving policy and care. Peer support specialist programs were highlighted as one effective, evidence-based way to elevate those with lived experience and transform systems and quality of care. One member of the group shared their experience with a peer support specialist, “I have my therapy and my psychiatrist but having [a peer support specialist], someone who is coming from a similar viewpoint with substance use or mental health - you’re more comfortable. You're talking to someone you can relate to. It’s a helpful experience.” We also heard about Peers Organizing Community Change (POCC), a program of the Alameda County Behavioral Health Office of Consumer Empowerment that started with less than 100 members and now has over 1,600. They developed a ‘peer mentors upon discharge’ program to support folks leaving psychiatric facilities. This has reduced re-hospitalizations by 72%. Despite the great success in Peer support models, there are several barriers to building and maintaining these programs, and also to effectively supporting and empowering those in Peer roles. Several opportunities for change have been identified. These include; 1.) The creation of more varied positions, job classifications, and growth opportunities for Peers. 2.) Pay rates for Peers should be shared transparently across the state and should be commensurate with other staff. 3.) Those with lived experience should be engaged in decision making at a policy level.

Data as an Equity Strategy

Collecting and using REAL (race, ethnicity and language) and SOGI (sexual orientation, gender identity) data in a person-centered way is critical to understanding the populations being served in care systems, and to delivering equitable, effective, accessible, and compassionate primary and behavioral health care. Delta Center CA participants called for DHCS to align their SOGI and REAL data collection efforts with the Federal USCDI V2 standards to incentivize and build capacity for data collection at the provider level and ensure that all of California is “speaking the same language.” Delta Center CA Learning Lab Teams have been hard at work creating data dashboards to see REAL and SOGI measures and to better understand access but feel as if they are “designing in the dark.” Additionally, participants called for a behavioral health advisory group to support the state’s quality improvement and data exchange efforts in a patient-centered way.

Building and Navigating Partnerships Across Systems

California’s behavioral health and primary care systems are currently fragmented, creating barriers to fruitful and effective collaboration to advance care integration. Clear communication, resources and the flexibility to promote partnership building, mutual respect, and the inclusion of community members in decision making will be critical to building a more integrated care system. Participants highlighted the Certified Community Behavioral Health Clinic (CCBHC) model as a way to advance collaboration and integration across systems in California, and the importance of pursuing the upcoming Federal CCBHC demonstration grants. Members of Delta Center CA Team Eagles, who represent one of California’s CCBHCs, shared information on how their CCBHC has benefited patients and providers, improved access to care, enhanced quality of care and health outcomes, and advanced equity.

Partnership can also be built across systems by way of workforce development. Community-based behavioral health organizations (CBOs) can greatly benefit from having the opportunity to work with medical students or residents. These physicians in training can gain meaningful experiences providing services to vulnerable populations in their local communities. This bidirectional relationship provides support to CBOs, community members, and also supports workforce development and retention in under-resourced areas. That said, many educational institutions have more traditional placements and are less open to partnering with CBOs or behavioral health placements as they typically cannot provide compensation. This is an excellent opportunity to provide funding for training placements for medical students and residents in community-based mental health organizations, and to enhance partnership between primary care providers and CBOs.

Expanding Access to Care through Telehealth

Telehealth can be a profound tool for expanding access to behavioral health and primary care. In order to be successful, it must also be offered alongside supporting resources that consider equity and patient preference. Delta Center CA participants presented a case study surrounding the use of the PHQ-9, a depression screening tool, via telehealth. There are many considerations when administering a tool via telehealth; these include whether the staff member has rapport with the patient, is asking the questions with care or is simply ‘checking a box’, and if the provider is asking the questions in a potentially stigmatizing way. The patient may not feel that they are in a safe, private environment, and they may not be comfortable with technology. This highlights the opportunity to provide further training and technical assistance to all staff members and providers at the state level. Additionally, there is a call for financial support of ongoing research to continue to build an understanding of where telehealth has been successful, and where there have been pitfalls. For example, do we fully understand how telehealth has impacted quality of care? What about engagement in future services? What has the patient experience been and how have these differed by patient population?

Cultivating a Vibrant and Well Workforce

Finally, California’s primary care and behavioral health workforce has experienced tremendous stress over the last couple of years. There is an opportunity to strengthen this workforce through policies and practices that create stronger career pathways for peers, provide support for Black, Indigneous and People of Color, and to foster a culture of belonging for all. Many Delta Center California Learning Lab Teams shared challenges in recruiting and retaining staff. For example, “CBOs are always cycling staff, creating disruptions to care for Medi-Cal clients. Clinicians and behavioral health support staff frequently leave for other opportunities because the compensation and benefits are better. CBOs need better rates to help them keep up with other plans/providers/private systems.” There is yet another critical opportunity to increase and/or right size rates so that CBOs and FQHCs are able to attract and retain a talented, diverse workforce. Further, adequate compensation can reduce compassion fatigue, burnout, and moral distress.