Strengthening Cross-System Collaboration to Improve Coordinated Service Delivery:Recommendations from Third Sector's Work with Sutter Yuba Behavioral Health Conservatorship-Focused FSP
In complex public systems such as behavioral health, client outcomes often depend on seamless coordination among agencies and departments. Navigating siloed systems poses a significant risk of crisis for the most vulnerable individuals, where a lack of intentional cross-system collaboration often leads to people falling through the cracks. As public systems evolve toward more integrated models of care, the need for seamless coordination is growing.
In California, this need is even greater with new legislation, such as Senate Bill (SB) 43, that emphasizes cross-departmental collaboration among agencies serving some of the most vulnerable populations. Specifically, SB 43, passed in October 2023, expands the state’s definition of Grave Disability to now allow for involuntary psychiatric holds and conservatorships for individuals with severe substance use disorders or those unable to provide for their own personal safety or medical care. This expanded eligibility has direct and significant implications for local behavioral health departments and public guardian offices, including:
- Expected increase in clients under conservatorship for both behavioral health and public guardian offices;
- Heightened frequency of inter-agency collaboration between public guardians and behavioral health staff to streamline client care; and
- Establishment of new or updated policies and procedures designed particularly for individuals under conservatorship who meet these expanded criteria.
Without intentional coordination, policy changes such as SB 43 that require increased collaboration across systems can strain staff capacity, create confusion and conflict around roles between agencies, and ultimately result in fragmented services for those most vulnerable.
To prevent confusion and ease the transition process, Third Sector supported Sutter-Yuba Behavioral Health’s (SYBH) conservatorship-focused FSP program in strengthening its collaboration and coordination with both the Sutter and Yuba Public Guardian (PG) Offices to provide behavioral health care services to individuals under conservatorship through cross-sector workgroups that clarified roles and responsibilities and developed clear procedures for all stakeholders, resulting in stronger cross-departmental collaboration and more supportive consumer experiences.
Below are four recommendations to strengthen cross-system collaboration, based on our work with SYBH and both the Sutter and Yuba Public Guardian Offices, focused on improving client care coordination.
1. Create Space for Connection
Creating spaces for teams across various systems to build relationships can foster greater trust and understanding, helping to break down silos and strengthen the foundation for collaboration. To kick off workgroups with the SYBH conservatorship-focused FSP team and both Public Guardian Offices, we held an in-person meeting with all stakeholders involved. This session aimed not only to preview the workgroup and align on objectives, but also to create opportunities for stakeholders from different agencies to connect and get to know one another in a less formal and lower-stakes setting.
2. Map Current Strengths and Challenges
Conducting an honest inventory of existing processes (e.g., tools, communication protocols) helps surface the factors that support or hinder collaboration between teams and systems. For the SYBH FSP team, the Sutter Public Guardian Office, and the Yuba Public Guardian Office, we facilitated separate discussions with each group to understand their internal processes for collaboration. We asked each team to highlight what was working well and what wasn’t in their collaboration and coordination, which led to expanding the use of successful tools, such as a shared transport calendar. It also revealed critical roadblocks to collaboration, such as unclear communication processes around urgent care responsibilities. Lastly, we had each group complete an exercise to map their collaboration with one another on a collaboration continuum, providing insight into their current state of coordination.
3. Co-Design Procedures and Processes
All system partners should be involved in developing procedures and processes to support coordination. This can help prevent gaps in coordinated service delivery for individuals. The SYBH & Public Guardian workgroup included frontline staff, managers, and supervisors from both Public Guardian Offices and SYBH’s FSP team. With all stakeholders at the table, we facilitated discussions in which they made decisions on roles, responsibilities, and processes, which were documented and developed into standard operating procedures (SOPs) and visual workflows, specifically for areas where coordination between Public Guardian Offices and SYBH is critical to providing quality care to individuals under conservatorship.
4. Create Space for Continuous Improvement
Establishing a consistent, dedicated space for collaboration and proactive challenge resolution (e.g., a monthly workgroup) helps maintain and continuously improve cross-sector collaboration. As we wrapped up our work with SYBH and Public Guardian Offices, we wanted to ensure they continued to have a dedicated space to problem-solve and troubleshoot coordination, and we suggested they maintain a designated time to meet, focused solely on continuous improvement. All three teams agreed to hold bimonthly meetings to ensure that the finalized standard operating procedures (SOPs) and flow charts remain current and to address any challenges in coordinating care for clients, especially as the system takes on higher-acuity clients post-SB 43.
The SYBH-Public Guardian collaboration demonstrates a model for improving cross-system collaboration and developing a coordinated approach to service delivery that best meets consumers’ complex and cross-departmental needs. By applying these four intentional steps— Connection, Assessment, Standardization, and Continuous Improvement—agencies can proactively improve cross-system collaboration and ensure clear, consistent support for vulnerable populations.
