California Health Care Improvement Projects (CHIPs)
California Health Care Improvement Projects (CHIPs) are designed by CHCF Health Care Leadership Program participants with the goal of addressing meaningful challenges or opportunities in health care.
Browse CHIPs to leverage the work of CHCF alumni and find opportunities to collaborate in order to improve health for Californians.
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Monterey Integrated Systems Transformation Initiative
Lindsey O’ Leary, LMFTPeople in Monterey County with complex physical health, behavioral health, and social needs often experience fragmented and ineffective care, leading to poor outcomes and high service use and cost. In response to improving health outcomes for our Monterey County residents, Monterey County Behavioral Health launched the Monterey Integrated System Transformation Initiative. This countywide initiative is designed to help all services become aligned with our most important values for the people who need our help the most.
October 25, 2023View/Download PDF
The Trauma Informed Care Experience
Angel Rodriguez , LCSWThe project focused on providing trauma informed care training to staff members to address allegations of hurtful, aggressive, and derogatory comments made towards foster youth in care. The primary goal was to educate staff on how to realize, recognize, respond, and prevent re-traumatization of these vulnerable individuals.
The need for this training arose after an investigation substantiated the allegations, and it became clear that a corrective action plan was necessary to ensure a safe and supportive environment for the foster youth. The project aimed to implement a comprehensive training program that would effectively equip staff members with the knowledge and skills required to deliver trauma informed care.
The training not only focused on teaching staff about the impact of trauma on foster youth but highlighted the into the importance of self-reflection and self-awareness.
This project and topic were inspired by my personal experience as a single father who witnessed his daughter experience.
October 25, 2023View/Download PDF
Optimizing Safety-Net Primary Care Access in the Era of COVID-19
Manuel Campa, MDPrimary care practices in the safety-net face increasing demands for services as the COVID-19 pandemic has elevated health awareness and state initiatives continue to expand Medi-Cal coverage. At Los Angeles General Medical Center (LA General), the largest primary care site within the Los Angeles County Department of Health Services (DHS), we noted that the years of deferred care, rapid primary care panel growth, and marked workforce attrition pushed our clinics to the breaking point. Primary care provider visits were backlogged, wait times for appointments were months long, and clinical outcomes and patient experience metrics were stagnant or worsening.
As the stewards of primary care access for nearly 58,000 patients across 9 unique medical homes, we heeded the call to disrupt the status-quo and began our journey to design and implement an alternative model of access to meet the competing needs of our patient population. Our vision was to use human-centered design methodology and understand the needs and experiences of all end-users. Our objective focused on developing an innovative solution that integrated medical home team-based care concepts and virtual health tools and technology to improve primary care visit capacity utilization (reduced % monthly visits not utilized, reduce % visit no-show, reduce third next available appointments [TNAA]) and balance clinical quality outcomes in our Quality Incentive Pool (QIP) Program and reported patient experience scores in the Press Ganey Medical Practice Survey (PG-MPS).
October 25, 2023View/Download PDF
The Intersection of Health Equity, Burnout and Trauma-Informed Care
Ashley Sens, MDThe advancement of Health Equity, including the identification of outcome gaps and the development of processes to close those gaps, has become a major focus for the Centers for Medicare and Medicaid Services as well for managed commercial insurance plans. This project was designed to identify the most significant and urgent Health Equity opportunity within a county hospital and to create a pilot intervention to close high priority identified gaps.
October 25, 2023View/Download PDF
Improving Access to Mental Health Services in L.A. County Schools
Michael Brodsky, MDThe crisis in adolescent mental health was highlighted in 2021 bulletins from the Surgeons General of California and the United States. Even before COVID, the incidence of adolescent major depression, suicidal ideation, and emergency room visits was on the rise. The profound death toll, sense of fear, economic disruption, and social isolation exacerbated the unprecedented stresses facing American youth. Communities of color were particularly hard hit by the twin pandemics of COVID-19 and systemic racism. Public school systems in Los Angeles struggle daily with mental health crises for individual students and with their cumulative impact on the learning environment. In 2018-19 there were 7,661 incidents of suicidal ideation on campuses in the L.A. Unified School District alone.
The School Behavioral Health Incentive Program (SBHIP) provided the opportunity for Medi-Cal health plans to earn implement programming to help address this crisis. This CHIP project aimed to improve access to mental health services for children and adolescents in school districts across L.A. County. L.A. Care Health Plan collaborated with Health Net and the L.A. County Office of Education to plan, pilot, and implement a $24 million project to bring telehealth services to students in multiple L.A. County school districts.
October 25, 2023View/Download PDF
Wesley Behavioral Health and Wellness Center
Aspen Burnett, LCSWDevelopment of a Behavioral Health and Wellness Center that would provide comprehensive services and coordinated Behavioral Health Care by establishing a Certified Community Behavioral Health Clinic (CCBHC) to reduce health disparities.
The program will engage people who are experiencing homelessness, unstably housed or residents of Skid Row downtown/Metro area of Los Angeles. The programs focus will be on people of all ages and their families who maybe experiencing serious mental illness, substance use disorder, and other Behavior issues. Including maladaptive Behavioral patterns related to chronic health conditions.
The center will provide treatment that is patient centered, trauma informed, recovery oriented, and integration of physical and behavioral care that will serve the whole person.
October 25, 2023View/Download PDF
Partnerships for School Health Care Requirements
Mithu Tharayil, MDMy initial point of inquiry was to better understand what we mean by “equity” and how to operationalize it. In June 2020, employees throughout San Mateo County Health walked out to collectively grieve the murder of George Floyd by police and publicly commit to dismantling the structural racism within our health care system. But what would this look like? How could we translate broad statements into actual wellbeing for our communities? For me, we needed to start by asking our patients and communities these questions and collaborating to implement solutions. If patients determine our health care system’s improvement priorities and co-create solutions, we ensure that those most impacted drive solutions responsive to their experiences. While laying groundwork for community engagement, an urgent need arose with which we could pilot our efforts to pilot equitable care: nearly 1,000 students, mostly Latinx and uninsured, were being excluded or threatened with school exclusion due to school vaccination status. In a novel partnership, the health department, county medical center, and county office of education collaborated to develop temporizing solutions including pop up vaccine clinics, direct scheduling opportunities, and policy guidance discouraging school exclusion.
These measures mitigated the immediate problem, but the county needed to address structural health care inequities to prevent recurrence. I convened a steering committee representing schools, clinics, the health department, and the health plan. We interviewed families who came to these clinics to understand the barriers that resulted in school exclusions despite their efforts to meet requirements. This led to three arms of work: 1) standardized communications to communities, and between health and schools; 2) health care access with specialized services for newcomer students and families, and new mechanisms for schools to connect students to appointments; and 3) learning communities for school staff to support each other with health-related services. So far, this academic year, we have identified fewer school exclusions, have decreased wait times for health care appointments within the safety net clinics, and continue to push coordinated communication to prevent school exclusion.
October 25, 2023View/Download PDF