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

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.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.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.Participants: Twenty-five semi-structured interviews with 49 leaders from LAC health systems, community-based organizations; and payers.Main Outcomes Means: Grounded the­matic analysis of interview data.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.Ethn Dis.2018;28(Suppl 2):397-406; doi:10.18865/ed.28.S2.397.