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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COVID-19 Data to Action: From Bean-Counting to Beanstalk-Climbing
Darpun Sachdev, MDThe COVID-19 pandemic illuminated longstanding vulnerabilities in public health disease response, lab reporting, technology, and our workforce capacity to address a surge in a novel respiratory virus. Prior to COVID, I had gained extensive experience leading data-driven HIV and STD programs in San Francisco and collaborating across siloes improve population health outcomes. Stepping up to lead San Francisco’s COVID-19 contact tracing program, I witnessed the ability of public health to rapidly improvise new structures, remove red-tape, cultivate a new workforce and transform data systems.
San Francisco implemented one of the nation’s most intensive, comprehensive, and multipronged COVID-19 pandemic responses. As COVID-19 response priorities shifted during the past two years, I utilized the CHIP to understand public health lessons learned during the pandemic, identify opportunities to improve and ensure limited resources are used to build systems that drive meaningful public health action.
October 25, 2023View/Download PDF
Providing Mental Health Services to High School Students in a Mental Health Dessert
Romana Crespo-Belarde, MSW, LCSWMental health needs in our communities are soaring, especially in our high school students. Adolescence is a time when young people are struggling to fit in, socially and emotionally. They are especially vulnerable to bullying, family dysfunction, problems in school, and trauma. Any of these situations may trigger a mental health issue. Mental health problems can affect a student's energy level, concentration, dependability, mental ability, and optimism. Research suggests that depression is associated with lower grade point averages, and that co-occurring depression and anxiety can increase this association.
Families served by White Memorial Community Health Center, a FQHC Look-Alike in Boyle Heights, have communicated the need for culturally and linguistically sensitive, in-person mental health services for their children. Adolescent patients at our clinic have shared their concerns related to increased symptoms of anxiety, depression, trauma, and suicidal ideation.
This CHIP project aims to develop and coordinate a partnership to provide in-person mental health services to students at an underserved high school in Boyle Heights.
October 25, 2023View/Download PDF
Beyond the X-waiver: Normalizing MAT Prescribing in Primary Care
Dawnell Moody, DO, MPHIn January 2023 the DEA and SAMSHA announced elimination of the X-waiver as a requirement to prescribe Suboxone (buprenorphine/ naloxone) for opioid use disorder which presented an opportunity to reduce one barrier to treatment, access to X-waivered providers, among patients at a suburban community health center. This project looked at the willingness of primary care providers not previously X-waivered to begin prescribing Suboxone for patients on a stable dose before and after a peer-led training. It further assessed if there was a difference in willingness to prescribe buprenorphine for chronic pain vs opioid use disorder. Prior to the training, 60% of providers indicated they were likely to prescribe buprenorphine for an indication of chronic pain or opioid use disorder and 40% of providers responded they were not likely to prescribe for either indication. After a one-hour peer training and the creation of a reference guide the number of providers likely to prescribe for an indication of chronic pain was 71% while the percentage likely to prescribe for opioid use disorder was 57%. Those not likely to prescribe for chronic pain dropped to 28%, but the number not likely to prescribe for opioid use disorder remained nearly the same at 43%. During the three months between the peer training and data collection one provider began sending Suboxone prescriptions for a patient with opioid use disorder. In the post-training survey, a question was asked about the new DEA license renewal requirement to complete 8 hours of education on substance use disorders which started in June 2023. Out of the two providers who completed the new requirement one felt it increased their willingness to prescribe MAT and one reported it had no effect.
October 25, 2023View/Download PDF
“DARE” TO WIN: Empowering the Future Nursing Workforce
Sharon Cobb, PhD, MSNAs the largest health care profession, the nursing workforce is a major contributor for improved health outcomes and enhancement of the patient care experience. Despite our diverse patient population, this is not reflected in the racial and ethnic composition of the California nursing. workforce, resulting in concerns for cultural and linguistic congruency. Focus should center on upstream factors driving workforce inequities, which include lower rates of retention and graduation. among under resourced minority students in health care professional programs, including nursing. and medicine. Attributed to a myriad of biopsychosocial and educational factors, underrepresented.
minority students are primarily from underserved communities, experience multiple adverse life events, and exposed to an increased risk of toxic stress and systematic injustice.
At my institution (Charles R. Drew University of Medicine and Science), over 80% of the nursing student population identify as African American or Latino and faced challenges listed above. To increase student success, my CHIP project centered on the development and implementation of an innovative educational model for at-risk students to increase retention, graduation, and matriculation into the health care workforce.
“DARE TO WIN” Model: D = Data Driven Needs Analysis; A = Academic Preparation and Rigor.R = Resource and Navigational Support, and E = Empowerment Approach and Support
To implement this model, key stakeholders (i.e., students, faculty, community, and health careleaders) were involved and gaps analyzed
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Building a One-Stop Low Vision Rehabilitation Center
Sally Dang, OD, MPHPermanent vision loss is prevalent among the aging and will continue to rise. There are gaps and barriers resulting from fragmented care locally and globally. The health inequity among the aging, visually impaired population is also a public health issue with an economic burden on state and federal resources. The CDC reports that 4.5M over age 40 report that they are blind. This number is expected double to 9M by 2050. There are 21M more who reports having “vision problems” not correctable with conventional glasses, contact lenses, or refractive laser surgery. California spends up to $14B for this population alone (one of the highest states), with medical costs totaling $5.7B annually and $3.4B for the 65 and older age group. People with severe vision impairment are more likely to have poor health and comorbidities, and 59% of these individuals reported having a fall in the previous year (CDC, 2022).
Patients with all levels of visual impairment may have difficulties performing activities of daily living, resulting in decreased quality of life. The ideal model has been tested at the Veterans Affairs, where I have spent the past ten years implementing best practices. The training programs are goal-oriented and successfully help individuals reintegrate into daily life activities. The feedback from Veteran patients on the impact on their quality of life and mental health has been overwhelmingly positive. This CHIP is aimed to scale a similar sustainable and holistic model that is not currently available to the broader community.
October 18, 2022View/Download PDF
Decreasing Decay Rate in Children under Three by Introducing Early Oral Health Education in Pregnant Mothers in Safety Net Clinics
Connie Kadera, DDSDental Decay is the most common chronic disease among school aged children. In fact, dental disease is more common than childhood asthma. By the time children go to school, 50% of them have already experienced tooth decay in California. As a result, children miss school, learn less, are in pain, or end up in the emergency room due to oral infections. Research, and reports support this position (California Children’s Report Card gave a C- for Oral Health Care in 2020). Treating decay in very young children is very challenging. The good news is that decay is a totally preventable disease. Using a multi-disciplinary approach for early education and intervention with expecting parents, I expect children to have a reduced rate of dental decay by the time their children are 3 years old.
Several efforts to decrease dental decay have already been implemented. Safety net clinics, such as Marin Community Clinics have treated children from the moment, they have their first tooth. Expecting parents are referred early on for dental care. Despite all these efforts, we are still seeing dental decay as a chronic disease in very young children. Our population is not completely aware of the etiology of this disease and the lack of understanding and knowledge is producing little effect in preventing tooth decay.
October 18, 2022View/Download PDF
Cultivating Outcomes through Equity in Behavioral Telehealth
Jennifer Clancy, MSWAs behavioral health needs skyrocketed when the COVID-19 pandemic took hold, specialty behavioral health organizations which provide services to people with serious mental illness and/or substance use disorder pivoted to delivering significantly more care via telehealth. While behavioral telehealth access may be a point of pride, racial inequity is also evident in telehealth access. It is disproportionately inaccessible to people of color, in particular those from the Black and Latinx communities, people with limited English proficiency, people facing poverty, and older adults. The key structural barriers often cited are limited access to broadband or technology and lack of digital literacy. However, institutional racism in behavioral health organizations also influences other practices and policies that negatively impact not only telehealth access but also quality. When behavioral telehealth access and quality are both compromised due to racism at structural, personal, and interpersonal levels, inequities in behavioral telehealth outcomes will also persist. As the specialty behavioral health system integrates learning from the dual public health crises of COVID-19 and racism into more permanent telehealth practices, racial equity must be named as a central aim.
This CHIP aims to help organizations address these issues by launching Cultivating Outcomes through Equity in Behavioral Telehealth, a 16-month learning collaborative. I designed the model using feedback gained between January-December 2021 from key informant interviews and Expert Meetings with behavioral health leaders, providers, and clients from underserved communities. I recruited diverse faculty and coaches with expertise in operationalizing strategies to counter structural racism in behavioral health and improve the engagement of people from minoritized communities in telehealth. This collaborative is funded by the California Health Care Foundation. Its goal is to help specialty behavioral health organizations make racial equity in telehealth a strategic priority to improve their behavioral telehealth and hybrid practices. The initiative aims to ensure clients have equitable access to high-quality services that promote meaningful outcomes and flourishing for people from communities with historic behavioral health inequities.
October 18, 2022View/Download PDF