The Transformational Change Partnership works with teams from county agencies to help them improve the health and wellbeing of their communities. Participants learn and apply the knowledge and skills required to increase access to high quality services that improve outcomes and reduce disparities.

The partnership was initiated by the Mental Health Services Oversight and Accountability Commission (MHSOAC), based on the success of several Commission-sponsored multi-county learning collaboratives that helped county behavioral health agencies develop more effective approaches to reducing the most severe consequences of untreated mental health issues. 

a meeting of transformational change partnership's first cohort
Timeline:

2022: The Commission was authorized by the Legislature to invest $5 million of Mental Health Service Act funds to initiate a university-based program that would build upon the learning collaboratives by working with teams from county agencies to develop the skills required for transformational change.

2023: Through a competitive process, Pacific’s McGeorge School of Law, Third Sector Capital Partners, the California Institute of Behavioral Health Services, the Stanford Center for Youth Mental Health and Wellbeing and the Steinberg Institute were selected by the Commission to design and launch the Transformational Change Partnership.

Fall 2023: A pilot cohort of two counties—the behavioral health agencies in Placer and Nevada—launched.

Spring 2024: A second cohort launches, with more to follow.  

Based on a survey conducted in the beginning of the first cohort, participants seemed less confident in their own abilities or those of their counties in a couple of key areas. These areas are opportunities for the Partnership to provide counties with targeted support and additional tools that will be particularly valuable in growing their abilities to develop and implement high-quality, outcome-focused projects. 

The assessment process is structured to provide consistent feedback to make real time adjustments that will improve future cohorts to progress toward their goals. Additionally, the evaluation process will also assess whether the elements provide the skills and abilities to drive transformational change. The evolution of the Fellowship will be heavily based on its contribution to transformational change. 

The Fellowship will also provide information to state policymakers and administrators in designing and implementing reforms intended to improve results of behavioral health services and reduce their disparities. 

While the Partnership currently focuses on behavioral health, it will include other social programs in the future.  

In addition to helping community-level agencies improve their service systems, the Transformational Change Project aspires to inform and improve the state policies and administrative practices that define and shape the services provided by counties and other local agencies.

Working deeply with local agencies to improve lives can also yield insights for state policymakers and administrators on ways to make it easier for county teams to implement state initiatives and to steadily move toward a more integrated, comprehensive and sustainable approach that can be tailored to communities and individuals.

Strong relationships are essential to transformational change, and some of the most important relationships are those among government agencies, across communities and between state and local governments. And just as feedback loops are key to making sure that services are meeting the needs of community members, feedback loops can help state officials understand the barriers to improvements within their control. 

A continuous improvement process has been built into the Partnership so that intentional learning can improve the value of the program for participating agencies and the Californians they serve. This internal assessment is also gathering information and insights that can be shared with system partners—state policy and administrative professions, leaders in the health care and provider community, academia and philanthropic foundations.  

Principles

These principles model and define professional norms for participants and partners: 

1. Co-create with community and organizational partners.  

The program is grounded in the transformational power of involving people who are being served as full partners in defining needs, designing actions and assessing for iteration. 

2. Meet participating teams where they are and support cooperative learning.  

The program aims to support transformational change by working with teams from participating organizations and adapting and aligning content and support to the circumstances and goals of those teams. 

3. Enable leadership throughout organizations.  

Transformational change requires ownership, responsibility and empowerment at all levels of an organization. 

4. Collaborate with experts.  

The program seeks to connect and integrate research, knowledge and practice to improve services and inform research priorities.  

5. Build on best available approaches, tools and resources.  

The program seeks to provide the best available information to practitioners, respect and honor the work of others, and support a culture of cooperation among change agents to accelerate transformational change. 

6. Create open-source materials to pay it forward.

The program adapts and develops resources over time and gleans learnings and insights, which are shared beyond those participating in the program to inform and encourage others pursuing transformational change.  

7. Improve through iteration. 

The partners are committed to learn by doing and recognize that through iteration and continuous improvement the program provides increasing value over ​​time.  

8. Address disproportionality. 

Reducing and eliminating inequities in health and care outcomes is an integral goal of any effort to transform service delivery systems. Systems don’t improve if programs and services continue to fail segments of the target population. The program encourages participants to focus their projects on communities that have historically been the least resourced or most adversely affected by ​​policies. 

9. View systems holistically. 

Disparities and poor outcomes are often symptoms of larger system-level dysfunctions. The program examines challenges as elements of larger systems, considering how those challenges relate to continuums of care and exploring both near-term and longer-term changes that improve system function over time. 

The partnership aspires to advance the knowledge of transformational change for educators, technical experts and researchers, as well as practitioners.

In ​​designing the program, the partners developed a conceptual learning model that articulated what participants need to know, need to know how to do, need to experience and need to feel.

Based on that assessment, a set of “change building blocks” were developed that incorporated that ​necessary ​knowledge, skills and abilities. Progressions were developed to align and integrate the information for participants from the building blocks into the process of designing and implementing an improvement project.

The Partnership is assembling and synthesizing the research base for each of the change building blocks, as well as analysis and experience from implementation and replication efforts.

None of the change building blocks are new to the field of system change, and some of them are tested and reliable elements of change management. However, some of the elements are relatively new, rapidly maturing and have only recently been applied to behavioral health or broader efforts to improve the social determinants of health.

For example, community engagement strategies are rapidly maturing beyond providing information or even consulting with the public to empowering community members to set priorities and shape the design of services. Those developing practices are being integrated with human-centered design to rethink all aspects of service delivery, with the additional intent of tailoring services to racial and cultural characteristics of communities and individuals to reduce disparities in access, quality and outcomes.

Work products developed through this activity will be posted to inform discussions, discernment and ongoing improvements to the Partnership and the field of transformational change. 

Ten change building blocks 

  1. History, context and system elements: Participants begin by understanding the current state of the behavioral health system within their counties. Participating agencies can understand how to reduce disparities in access, increase quality of care, increase positive client outcomes and lead to sustained system improvement.

  1. Planning transformational change: After identifying a focus area, participants create a plan to drive positive outcomes for targeted communities. The purpose of planning is to generate common, documented agreements among the system partners and anticipate challenges, deviations and potential risks to success.

  1. Data for transformational change and management: Participants work from their end goal to the starting point where they identify key data streams that measure their success and progress through the improvement project.

  1. Hearing and developing with community: Through the Partnership, an authentic community engagement process fosters effective program development. To be effective, teams need to listen and understand the experiences of community members.

  1. Building a resilient workforce: Encouraging employees to innovate and improve work processes only increases turnover within local agencies. Strategies to better support overworked staff should also be incorporated into projects.

  1. Managing partnerships: Strong relationships between organizations and individuals drive transformational change by identifying target prevention and intervention strategies that address community needs. These relationships are only successful through trust, coordination and a shared goal.

  1. Integrating and coordinating: Comprehensive, holistic and tailored care requires integrating health, behavioral health, social and other supports and services that are often provided by different agencies and fragmented programs.

  1. Innovating and iterating: Constantly looking to improve the current services within counties can help them develop responsive services and support.

  1. Improving efficiencies: Eliminating inefficient steps and activities helps reclaim time and reinforces the shared goal of communities.

  1. Leveraging financial resources: Fragmented funding, different eligibility requirements and compliance risk often undermine comprehensive and tailored care, while braiding and blending of funds can enable holistic care.  

The learning journey

The learning journey map groups ideas together so they can be delivered in an effective manner to county groups. The first progression covers strategic direction, the second progression involves relationships, and the third progression focuses on organizational infrastructure. Through these three progressions, the counties go through 10 “Change Building Blocks” that reflect the portfolio of knowledge, skills and abilities required for system-level changes within service-providing organizations.