Project Overview
The Transformational Change Partnership (TCP) is an innovative cohort program that uses a structured learning and capacity-building framework to empower teams in California to transform their behavioral health systems and improve outcomes. The program aligns with the state’s Behavioral Health Services Act (BHSA), which emphasizes improving access to care, reducing disparities, and fostering systemic integration across health, housing, criminal justice, and other sectors. Third Sector co-created TCP with the University of the Pacific.
In order to achieve a future where all people are able to achieve well-being, no matter their race, background, or circumstance, we must move beyond traditional public mental health services that work in silos toward more integrated and proactive approaches that address mental health from various angles. To realize this shift, county departments must develop the internal capacity to listen to communities and implement transformative change in partnership with the people they serve.
In 2024, amendments to California's Mental Health Services Act (now the Behavioral Health Services Act) emphasized improving access to care, reducing disparities, tracking outcomes, and fostering systemic integration across health, housing, criminal justice, and other sectors. Hundreds of behavioral health staff had to implement major policy initiatives that required them to redirect existing funding to deliver a reconfigured set of behavioral health services while working collaboratively with new agency partners.
The Transformational Change Partnership was developed to provide county health and human services teams and their partners with knowledge, learning experiences, and implementation support to achieve transformative system change, including the vision outlined by the BHSA. The Partnership is designed to help county agencies successfully implement current state initiatives and reforms to improve operations, relationships with community partners, and client and community outcomes. It emphasizes human-centered design, community engagement, and outcomes-focused care as essential to developing preventive, comprehensive, cost-effective care that improves lives and reduces disparities. The Partnership is a collaborative endeavor of the University of the Pacific McGeorge School of Law, Third Sector, the California Institute for Behavioral Health Solutions, and additional partners.
In the summer of 2023, Third Sector and the University of Pacific's McGeorge School of Law partnered to establish the Transformational Change Partnership. They developed the fellowship curriculum and selected two county behavioral health teams to participate in the pilot cohort to co-design, test, assess, and refine the program's training elements. Each team comprised behavioral health agency staff, including clinicians, program directors, and agency directors. Each team focused on an issue in their system that is currently or near-term important and is preventing them from serving their communities more effectively.
TCP Cohorts complete the "change progression," representing stages in the fellowship during which cohort members develop and implement change work plans while acquiring the critical skills needed for successful implementation and sustainability. The progressions and how they connect to each category of change building block are outlined in Figure 1 to the right.
In the First Progression, county teams assessed the current system and designed improvement projects to meet community needs. Participants learned skills focused on setting strategic direction and on strengthening their capacity to build meaningful community relationships, including human-centered design, root-cause analysis, and project management.
In the Second Progression, teams implemented their projects, built organizational capacity, and managed challenges. In this progression, participants learned by doing, building skills focused on overcoming resistance, change management, system co-production, and piloting and testing new programs to improve outcomes.
In the Third Progression, teams refined their projects and scaled successes to other areas, focusing on continuous improvement and innovation.
Since the launch, Third Sector has supported four cohorts and 10 county teams, each focused on different cross-sector policy and program transformations. Through the program, each team has deepened its data- and community-based skills and strategies, implementing service delivery improvements such as:
- Optimizing billing practices to ensure financial sustainability in response to CalAIM reforms
- Aligning programs to state reform efforts under AB 1810 and the CARE Act, including revamping the coordination of care after a client is released from jail
- Coordinating across behavioral health and education to implement the CYBHI All-Payer Fee Schedule
- Supporting a county’s implementation of its strategic plan, convening partners across education, health, human services, and workforce partners
In the TCP program evaluation, participants across the four cohorts demonstrated growth in their community engagement and co-production skills, as well as in their confidence in their ability to innovate within their systems and deliver coordinated care. Up to a year after the cohort concluded, county teams have also reported continuing to collaborate with their cross-sector teams to facilitate the continued implementation and sustainability of their improvement projects.
Behavioral Health
| Project Name | Scope | Location | Status |
|---|---|---|---|
| Incorporating Consumer Voice in Outcomes Design & System Improvements | County | CA | Closed |
| Sutter-Yuba’s iCARE Innovation Project seeks to increase access to behavioral health care for underserved groups not currently engaged in traditional behavioral health services. Third Sector is supporting outcomes framework design and outcomes impact assessment for iCARE by soliciting and integrating input from consumers to both inform continuous improvement efforts and contribute to consumer-defined recovery metrics. | |||
| Designing Outcomes-Focused Mental Health Services in Los Angeles County | County | CA | Closed |
| Third Sector partnered with the Los Angeles County Department of Mental Health (LACDMH) to transform approximately $300 million in service provider contracts, creating the nation's largest system of outcomes-focused mental health provider contracts. This multiyear, data-driven process focused on LACDMH's Full Service Partnership program, which supports a "whatever it takes" approach to caring for individuals with the most challenging mental health needs. As a result, LACDMH was able to deliver better outcomes for the more than 15,000 clients they serve each day. | |||
