Solano County Logo
In 2016 Solano County Behavioral Health Division (SCBHD), partnered with UC Davis Center for Reducing Health Disparities (CRHD), to launch a multi-phase five-year community-initiated Mental Health Services Act Innovation project known as the Interdisciplinary Collaboration and Cultural Infographic of Solano Innovations ProjectTransformation Model (ICCTM). The project focuses on highlighting the experiences and mental health needs of the Filipino American, Latino and LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning) communities of Solano County.

While significant disparities also exist for other ethnic/racial groups, these three populations were selected for this project because they have historically shown more severe patterns of disparities when accessing and utilizing County mental health services, compared to other populations in Solano County.

Traditional approaches used to engage and serve these three communities appropriately have focused mostly on the providers’ skill sets, and community engagement to improve utilization.

This project takes a decidedly collaborative and community-oriented approach to these challenges by creating a training curriculum based on the Culturally and Linguistically Appropriate Services (CLAS) standards - a set of nationally accepted standards for cultural proficiency in service organizations and information gathered directly from the three target communities.

This education, training, and problem-solving process brought together workgroups comprised of consumers, community and organizational leaders, advocates, and County and contract staff, to address identified barriers through CLAS-focused quality improvement interventions.

For ICCTM project detail, review the American Public Health Association roundtable presentation summary.  

Take a look at the video created at the onset of the ICCTM project. 

Solano County Behavioral Health Innovation Plan

The Solano County Behavioral Health Innovation Plan: A Cultural Transformation Model

Project Goals and Outcomes

Multi-Level Outcomes

On an individual level, the intervention participants would increase their knowledge, experience, and self-confidence in using Culturally and Linguistically Appropriate Services (CLAS) standards.

On a community level, the following outcomes would be evident: (1) increase in community outreach and community engagement; (2) increase community partnerships across the county; (3) improve awareness of mental health services; and (4) proven innovative strategies that decrease stigma of mental health in their respective communities.

On a county (systemic) level, outcomes include: (1) improve access and utilization of mental health services for Filipino American, Latino and LGBTQ+ communities; (2) enhance collaborative partnerships between County, Community, and Community Based Organizations (CBOs); (3) increase workforce diversity; and (4)

Quadruple Aim Framework

improve organizational policies, programs and support systems to ensure and sustain culturally and linguistically competency in service delivery.

“Quadruple Aim” Framework

This project is grounded in the Quadruple Aim framework — to-date the most effective evaluation model in healthcare — to measure the impact that the ICCTM will have on Filipino American, Latino, and LGBTQ+ mental health consumers in Solano County. 2014-2016 baseline data was used to assess change in access and utilization over time.

Core Project Components

Community-Engaged Research (CEnR) – A framework that is used to increase our understanding of mental health disparities associated with race, ethnicity, gender, sexual orientation, current gender identity, and socio-economic status, andToolkit for Reducing Health Disparities to increase community engagement to achieve mental health equity and increase access to care (Minkler & Wallerstein, 2008).

Culturally and Linguistically Appropriate Services (CLAS) standards – CLAS standards are designed to ensure that mental health consumers can access, utilize, and benefit from mental health services in the context of their language, race, ethnicity or other personal characteristics (Hollinger-Smith, 2016).

Quality Improvement (QI) and Sustainability – A focus on systematic and continuous actions that lead to measurable improvement in mental health services and the health status of targeted patient groups that sustain over time.

General project phases listed below provide an example of how this cultural transformation project may be adapted to fit your organization's needs.General project phases

Phase 1 (Years 1-2): Comprehensive cultural health assessment
Collect stories, histories and strengths of the Latino, Filipino American, and LGBTQ communities, Solano County, and community-based organizations (CBOs) and build on them
 
Phase 2 (Years 2-3): CLAS training and quality improvement (QI) plan development
Develop a CLAS leadership and program development training specific to the health and mental health needs of Solano County and use this transformational knowledge as foundation for quality improvement (QI) plans
 
Phase 3 (Years 4-5): Quality improvement plan implementation
Coordinate and implement Quality Improvement plans with coaching from a team from the Center for Reducing Health Disparities and feedback from the community to accomplish positive outcomes
 
Evaluation (Years 1-5): Quadruple aim and sustainable community engagement
Evaluate joint QI plans using a “Quadruple Aim” mixed-methods (qualitative and quantitative) approach that will examine: consumer experience, provider experience, health outcomes, and cost effectiveness
 
 
 

Providing Quality Care with CLAS Training Curriculum

The ICCTM is the first community-initiated project that combines CLAS with community-informed recommendations through a tailored curriculum.

The training consisted of four in-depth training sessions:Cover Page of Providing Quality Health Care with CLAS

Session 1: Overview/Health Disparities

Session 2: Community Needs/Gaps*

Session 3: CLAS Standards

Session 4: Quality Improvement Action Plan Development

*In Phase 1, CRHD collected hundreds of stories using qualitative research methods and spoke with a range of Filipino American, Latino, and LGBTQ+ individuals regarding the current state of mental health care and access in Solano County. Interviewees from SCBHD staff include both those, working regularly with community-based organizations providing services to each of the three priority communities and their consumers, and shared important insights into the larger context of mental health care service delivery in Solano County. The findings of these community needs/gaps guided the training and ultimately the quality improvement action plan development. 

Venn diagram of community, county, community-based organizations

Training ModelCover page of workbook for Providing Quality Care with CLAS

Inter-sectorial: Participants were selected from (1) SCBHD (2) Community Based Organizations (3) social services (4) schools (5) faith-based organizations (6) law enforcement (7) housing, (8) public health

Multi-stakeholders: Participants were selected from County, CBOs, and the Community. They included: (1) quality improvement staff members; (2) mental health providers; (3) community and county leaders; and (4) consumers and their family members.

Multi-Cohorts: Three cohorts were trained. Each cohort created 3-4 teams, each team created one quality improvement action plan, grounded in the community-defined challenges and community-defined solutions findings from Phase 1 efforts.

Qualitative Approach: Purposive sampling was used to ensure that we obtained a diverse sample of Filipino American, Latino, and LGBTQ+ individuals. To ensure a wide range of perspectives, interviewees included community members from the three priority communities with various community roles. Based on this data, the four key priorities to improve access and utilization of care are:

  1. Cultural Communication
  2. Culture and Community
  3. Workforce Education and Training 
  4. Systemic/Societal Determinants of Health

        Community Narrative Reports: Based on the qualitative data collected in 2016, a set of community specific narrative reports were created that summarized experiences shared by each of the three priority communities in describing their access and utilization of mental health care services in Solano County.

        Each report gives an overview of the community, outlines their mental health priorities, highlights barriers to accessing and receiving quality services, identifies their particular strengths and assets, and showcases their community-defined strategies and solutions to improve mental health service delivery in Solano County.

        Filipino American Narrative

        Filipino American Narrative Cover Page in English

        English

        Tagalog

        Spanish

         

        Latino Narrative

        Latino NarrativeEnglish

        Tagalog

        Spanish

         

        LGBTQ+ Narrative

        LGBTQ Cover Page in English

        English

        Tagalog

        Spanish

        Countywide Community Engagement:Solano County Community Based Organization Spanish BrochureSolano County Community Based Organization English Brochure

        The current project’s scope encompasses seven major cities in Solano County: (1) Benicia (2) Dixon (3) Fairfield (4) Rio Vista (5) Suisun City (6) Vacaville (7) Vallejo. We partnered with three (3) Solano County Community Based Organizations (CBOs), each with expertise working with one or more of the three priority communities. These CBOs’, in collaboration with Solano County are identifying individuals throughout the seven cities in need of mental health services and connecting them to treatment. Each CBO created a three-year workplan with specific community-identified strategies to help achieve project outcomes at the community level.

        Outreach/Engagement Efforts:

        Filipino American Community:
        Fighting Back Partnership Logo

        Fighting Back Partnership created the Filipinx Mental Health Initiative (FMHI)-Solano.  FMHI-Solano is a community-driven coalition which aspires to provide mental health access that is culturally responsive and meets the needs for the intergenerational Filipinx community. The mission of FMHI-Solano is to empower the Filipinx community by providing early intervention through education and access to resources leading to a resilient community.  Their Facebook page https://www.facebook.com/fmhisolano/

        Latino Community
        Rio Vista CARE LogoRio Vista CARE is partnering with organizations that celebrate Latino cultural events throughout Solano County to encourage community engagement opportunities to discuss Latino culture/identity/history as a strategy for mental health prevention and to promote wellness. Rio Vista, CARE is also partnering with clinical providers to coordinate CLAS ready support groups for the Spanish-speaking Latino community in Solano County.

           

        LGBTQ+ Community:
        Solano Pride Center LogoSolano Pride Center, in partnership with faith-based organizations is creating a sense of community and safe spaces for the LGBTQ+ population around mental health and well-being. Specific to LGBTQ+ youth of color, Solano Pride Center is developing peer support groups for parents to discuss risk factors associated with mental illness such as, stigma, discrimination, and isolation, while promoting culture, inclusivity, and mental health wellness.

        Intersect of the Filipino American, Latino, and LGBTQ+ Communities:

        Our three CBO partners joint efforts to create a Queer and Trans People of Color (QTPOC) initiative.  This initiative is helping develop, promote, and coordinate a space specifically for people of color that identify in the LGBTQ+ spectrum where they can safely discuss issues affecting them and the impact those have on their wellness.  This initiative will also help connect them to culturally and linguistically appreciate services. 

        Ten (10) quality improvement action plans were developed through this ICCTM project and fall into three areas of focus:  

        ICCTM BrochureCommunity-focused:  action plans containing recommendations prioritized in a way that helps SCBHD build better relationships with consumers, Community Based Organizations, and other organizations throughout Solano County. These action plans are geared to increasing mental health promotion and wellness by means of many different venues and strategies.

           

        Workforce-focused: action plans containing recommendations prioritized to help build a more diverse workforce within SCBHD and also to help better prepare the SCBHD workforce in “providing quality care with CLAS.” The recommendations in these action plans are geared to transcend HR policy changes, and to accommodate numerous career pathways, and to promote systemic workforce involvement with the Culturally and Linguistically Approproate Services (CLAS) Standards.

         

        Training-focused: action plans prioritized in a way that helps better train staff members for working with the three priority communities (with the hope to better prepare them for working with any diverse community).