LEVERAGING EXISTING INFRASTRUCTURE AND PARTNERSHIPS TO IMPROVE CHILD HEALTH OUTCOMES

The following information was released by the Institute for Healthcare Improvement (IHI):

By Center for Care Innovations

Summary

Building sustainable and effective community partnerships is at the heart of improving health outcomes for children and families. Communities can scale what already works to drive lasting change.

Strong community partnerships are key to healthier futures for children and families and the smartest solutions build on existing foundations instead of starting from scratch.

The team at L.A. Care Health Plan knows this well. L.A. Care Health Plan is an independent local public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. All of California's Medi-Cal managed care plans participate in the Child Health Equity Collaborative, a 13-month program run by IHI and funded by California's Department of Health Care Services. The goal of the Collaborative is to improve the completion of well-child visits in infants (030 months) and adolescents (1518 years).

The first phase of the Collaborative, for whichCenter for Care Innovations (CCI) is an implementation partner, focused on two key interventions for managed care plans throughout the state: actor maps and community partnerships. While working on these interventions, the L.A. Care team shared these insights on what it takes to tap into existing infrastructure and trusted relationships:

Be intentional and take your time. From brainstorming to evaluation, slow down to build trust and lay a solid foundation. This allows for quick recovery when change is needed. In other words, it makes the work more effective and even more efficient in the long run.

Build and maintain trust. Alignment of goals is critical, as is open communication. Share updates, good or bad, and invite your partners to help shape the work.

Stay aligned with your mission. Regular reflection ensures that you and your partners stay focused on the original goal and make progress.

How did participants successfully bring this all to life? Here are two promising practices or bright spots from the work of the team at L.A. Care Health Plan. These practices can help increase the completion of well-child visits, connect families to valuable resources, and ultimately improve health outcomes for children and families.

Promising Practice #1: Use actor maps to identify the right partners

The L.A. Care team's community partnership journey began with developing an actor map a tool used to visually represent key organizations and/or individuals that make up a system. The team used a two-step approach:

First, categorize community organizations by sector, such as education, community, and social services.

Second, identify key partners within those categories.

This structure, rooted in guidance from IHI and CCI, allowed the team and their pilot clinic, Northeast Valley Health Corporation (Northeast Valley) Sun Valley, to visualize not just individual partners, but also the cross-sector relationships that already existed.

L.A. Care and Northeast Valley then focused on aligning their new partnership with the needs of their priority patient population: children 030 months. Since these children are not yet in school, this required identifying community partners who could support parent and guardian education. The team first explored a partnership with Los Angeles (L.A.) Valley College, which provides parents and guardians in their community with resources such as childcare, monthly play groups, parent workshops and other supportive services. L.A. Valley College also had a pre-existing partnership with Northeast Valley. Although they ultimately had to pivot away from this partnership due to curriculum changes at the college, the thorough actor map made it easy to quickly identify a new community partner: L.A. Care Blue Shield Promise Community Resource Centers.

Flexibility in partnership work is essential. Being able to modify the approach, while maintaining focus on the end goal, ensures that progress doesn't stall. Because of their detailed actor map and a previously established relationship, the transition was smooth. Caroline Basil, Quality Improvement Project Manager at L.A. Care Health Plan, shared, "Pivoting was a lot easier than I thought, because of the robustness of our actor map. We were able to look right back and pick a new partner...it was a lot easier and a lighter lift than having to start from scratch."

The Community Resource Centers were an ideal partner because of the variety of offerings for children and families in the community. They have 14 centers throughout Los Angeles County that provide free services such as parenting classes, cooking and nutrition classes, yoga, and Zumba.

Together, these partners L.A. Care, Northeast Valley Health Corporation, and the Community Resource Centers decided to focus on services already being offered by the Community Resource Centers and Northeast Valley, instead of reinventing the wheel and starting a new intervention. The Community Resource Centers were already dropping off a calendar of activities to Northeast Valley monthly, which provided a place to start.

Promising Practice #2: Leverage touchpoints already in place to build on the partnership

The Community Resource Centers had been using referral forms to connect clients directly to free community classes and resources.

The partners decided to marry the monthly calendar of activities with the referral forms for patients at Northeast Valley, and so they implemented a test. After each well-child visit, providers and clinic staff could simply mark the applicable checkboxes on the referral forms and hand this list to parents and guardians. This small change did not disrupt clinical workflows or place undue burdens on providers. Instead, it turned every point of contact (front desk, provider visit, and check-out) into an opportunity for connection. A brief lunch-hour training course from the Community Resource Centers empowered the entire Northeast Valley clinic staff to use referral forms, making the impact both immediate and sustainable.

Caroline Basil from the L.A. Care team added, "It was a seamless way to incorporate something that was already there...we always want to do really big, grandiose interventions, but this was a simple and effective solution to utilize existing resources that were already in the community with an organization that has very similar values."

Continuing the Partnership

L.A. Care, Northeast Valley Health Corporation, and the Community Resource Centers remain committed to their partnership and to scaling their collaborative efforts. As a part of this commitment, the Community Resource Centers aim to continue hosting training sessions on implementing referral forms at local clinics. This train-the-trainer model will empower each clinic to tailor the process to their specific needs and integrate available resources into daily workflows. Expanding these trainings will strengthen community partnerships and ensure families are aware of and able to access valuable resources.

In addition, the L.A. Care team is exploring new opportunities to collaborate with Community Resource Centers across Los Angeles County. One initiative currently in development involves coordinating mobile clinic events in conjunction with the Community Resource Centers' annual "Back to School" programming. These events include backpack distributions, resource fairs, and family-focused activities, and offer an ideal platform to provide clinical care in a setting that is both convenient and engaging for the community. The foundation of trust that the partners have built will continue to power the work ahead.