HomeMy WebLinkAboutac-health-behavioral-health-department-strategic-plan-bhdAlameda County Behavioral Health (ACBH)Strategıc Plan
Table of Contents
I. Acknowledgements. . . . . . . . . . . . . . . . . . . . . . . . . .3
II. Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . .5
III. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
IV. Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
V. ACBH Commitment to Anti-Racism . . . . . . . . . . .12
VI. Themes & Strategic Directions . . . . . . . . . . . . . . .13
1. Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
2. Community Expertise . . . . . . . . . . . . . . . . . . . .19
3. Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
4. Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
5. Equitable Care . . . . . . . . . . . . . . . . . . . . . . . . . .34
6. Re-entry and Criminal Justice . . . . . . . . . . . . .39
7. Acceptable and Equitable Distribution
of Funds for MH/SUD Needs . . . . . . . . . . . . . . . .43
VII. Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46
A: Literature Review Documents . . . . . . . . . . . . .46
B: Sample Documents for Data Collection . . . . .47
Alameda County Behavioral Health (ACBH) Strategic Plan 3
Acknowledgements
Alameda County Behavioral Health Care Services (ACBH) would like
to acknowledge and thank all the many organizations and individuals
who helped to inform this Strategic Plan. The California Institute for
Behavioral Health Solutions (CIBHS) and the Equity and Wellness
Institute (EqWI) worked collaboratively to lead the strategic planning and
community engagement process and finalize the written Strategic Plan.
Adèle James Consulting also provided support through the facilitation of
focus groups and assistance with analysis of the community’s feedback.
Also, we would like to acknowledge the contributions of Sarina Hill,
ACBH Strategic Plan Project Manager, who worked alongside CIBHS and
EqWI to help with the design and implementation and coordination of
the strategic planning process.
We would like to thank our Board of Supervisors who helped to organize
listening sessions so we could hear from their region’s constituents.
This included:
> District 1: David Haubert
> District 2: Richard Valle
> District 3: Dave Brown
> District 4: Nathan Miley
> District 5: Keith Carson
Finally, great thanks to our broader Health Care Services Agency
(HCSA) teams and the Alameda County City Managers who all
participated in a listening session so city-specific perspectives could
inform the Strategic Plan.
I.
Alameda County Behavioral Health (ACBH) Strategic Plan4
> Side by Side
> Native American Health Center
> Hume Center
> Pacific Islander Wellness Initiative
> Filipino Community Health & Wellness
> La Familia
> Multilingual Counseling Center
> Felton Institute Early Psychosis Division
> Bay Area Community Services
> Telecare Corporation
> Options Recovery
> Independent Family Members
> Lincoln Families
> Alameda County Probation Department
> Alameda County Sheriff’s Office
> Superior Court of Alameda County
> Mental Health Advisory Board
> MHSA Advisory Board
> African American Steering Committee
> Peers Organizing Community Change
> Alameda Alliance for Health
> Community Health Center Network
> Mar Thoma Orthodox Church
> Lakeshore Avenue Baptist Church
> Allen Temple Baptist Church
> San Lorenzo Japanese Christian Church
> Friendship Christian Church
> First Presbyterian Church of Berkeley
> Community Based Organizations from California
Reducing Disparities Project:
• Catholic Charities
• Native American Health Center
• Gender Spectrum
• Safe Passages
• La Clinica
• East Bay Asian Youth Center (EBAYC)
• California Black Women’s Health Project
• Racial & Ethnic Mental Health Disparities
Coalition
We are also grateful to many of our community partners who assisted us with helping to recruit participants for our
focus groups as well as representing their organization’s perspectives in our key informant interviews which helped
shape the themes and recommendations of the strategic plan. This included:
> LGBTQIA2S+
> Indigenous/First Nation
> Asian American
> Pacific Islanders
> Southeast Asian
> African American/Black
> Latinx
Most importantly, we want to thank the clients, family members, and community members who are dedicated to
working with us to transform and improve behavioral health services offered in Alameda County. This included:
> Immigrants/Refugee
> Transitional Age Youth
> Older Adults
> Justice Involved Individuals
> Individuals with Substance Use Disorders
> Unhoused Individuals
> Family Members/Parents/Caregivers
Alameda County Behavioral Health (ACBH) Strategic Plan 5
Executive SummaryII.
Since 2019, California has been working on a foundational revisioning
of its behavioral health system, mental health and substance use system.
The state’s behavioral health modernization, in addition to current state
efforts that are transforming the behavioral health delivery system
such as California Advancing and Innovating Medi-Cal (CalAIM) and
Community Assistance, Recovery and Empowerment Act (CARE Act),
will have a significant impact on all county behavioral health systems.
Amid this statewide transformation, Alameda County Behavioral
Health Services (ACBH) is also committed to charting its own course for
strategic growth and evolution. ACBH leadership was dedicated to a
planning process that demonstrated the core values of being anti-racist
and centering the voices of clients, family members, and the community.
These values drove the strategic planning process.
ACBH sought out a consulting team that had significant experience
partnering with clients, family members and community. They engaged
the California Institute of Behavioral Health Solutions (CIBHS), who
partnered with the Equity and Wellness Institute (EQWI) to design a
community driven strategic planning process. Instead of hearing first
from ACBH internal staff stakeholders, the consulting team went out
into the community and intentionally prioritized the voices of those
from communities facing the greatest inequities to help shape the initial
themes and recommendations of this ACBH Strategic Plan. After the
community identified their priorities, staff at all levels of ACBH provided
feedback and helped to finalize the themes and recommendations.
Alameda County Behavioral Health (ACBH) Strategic Plan6
The Plan provides a roadmap for ACBH to:
1.
Increase access to services
co-designed with the
community.
3.
Increase vital employment
supports to individuals
who are unhoused through
increased collaboration.
6.
Seek alternatives to the
criminal justice system,
particularly for Black men
through increased coordination
between the criminal justice
serving agencies and ACBH.
4.
Improve programs to advance
culturally relevant services and
supports for Alameda County’s
diverse communities.
7.
Increase equity in funding
for substance use and mental
health services to address
co-occurring disorders and
reduce stigma against substance
use and addictive disorders.
5.
Increase equitable care
for communities facing the
greatest behavioral health
inequities, including the diverse
Asian, Black, and LGBTQIAS2+
communities.
2.
Uplift community expertise
to further shape program
policies and practices.
The Strategic Plan will help to guide ACBH’ efforts in areas that are of critical importance at the local level and are also
aligned with transformation focus areas at the state level. The Plan tailors’ recommendations to improve access to
equitable care, co-design whole person care, and increase culturally relevant services and supports. It calls attention
to the needs of communities and populations facing the greatest inequities, including the diverse Black, Asian, and
LGBTQIA2S+ communities, those who are or have been unhoused, or involved with the criminal justice system, and
individuals with substance use and/or addictive disorders.
Alameda County Behavioral Health (ACBH) Strategic Plan 7
Alameda County Behavioral Health (ACBH) Strategic Plan8
Background
Alameda County Behavioral Health Care Services (ACBH) recognizes that
over the course of the last three years, communities have experienced
major threats to their overall wellness as a result of the Coronavirus
(COVID-19) Pandemic. As COVID-19 was still considered a national
health emergency, there was also recognition across the country about
the need for social justice reform and a focus on health equity. This
continues to be tantamount to the behavioral health experience of the
general population.
Over the course of the past two years, behavioral health stakeholders
have also experienced significant change as a result of new statewide
initiatives, new legislation that has passed, and legislation that is
currently proposed. CalAIM, the largest transformation of Medi-Cal in
California’s history, is still being implemented and new services such
as enhanced care management, community supports, and others are
working to create a more coordinated, person-centered, and equitable
health system.
In 2022, the Community Assistance, Recovery, and Empowerment
(CARE) Act was passed. It provides community-based behavioral health
services and supports Californians living with untreated schizophrenia
spectrum or other psychotic disorders through a new civil court process.
In 2023, SB 43 was signed into law. Existing law provides for the
involuntary commitment and treatment of a person who is a danger
to themselves or others or who is gravely disabled. Prior to SB 43,
“gravely disabled” was defined as either a condition in which a person,
because of a mental health disorder, is unable to provide for their basic
personal needs for food, clothing, or shelter or has been found mentally
incompetent, as specified. SB 43 expands the definition of gravely
disabled to include the inability for a person to provide for their personal
safety or necessary medical care because of chronic alcoholism. The bill
would authorize counties to defer implementation of these provisions to
January 1, 2026.
III.
Alameda County Behavioral Health (ACBH) Strategic Plan 9
In 2024, California citizens will vote on SB 326, the Behavioral Health Services Act, a ballot measure that proposes
major changes to the Mental Health Services Act. The changes will shift funding for core mental health services that
have been shaped by the community since 2005 and instead dedicate 30% of all MHSA funds to housing interventions,
allow for the funding of substance use disorders, and eradicate the funding category of “Innovations” which was used
by counties to test new strategies to transform local behavioral health systems. All of these factors have brought our
department towards a renewed focus on the timely initiation of strategic planning and a process that opens the door to
our clients, families, and varied stakeholders. Our ultimate goal of this phase of strategic planning has been to help us
chart a future course. We endeavored to design a planning process that normalized discussions on race, racial equity,
and community engagement. Given that the changes over the past three years to our social landscape and policy
landscape have been so broad and sweeping, the ACBH Strategic Plan has been built on community engagement and
also highlights the need for continued outreach, engagement and action as we begin our implementation process.
Beginning in February 2022, ACBH commissioned a community-driven Strategic Planning Initiative with a multitude of
stakeholders, organizations, and communities across the County to create a long-term strategic plan in order to help
our system to:
1.
DEVELOP a more intentional
focus on serving the diverse
needs of the entire community,
including those communities of
color who have been traditionally
underserved, unserved, or
inappropriately served.
3.
IDENTIFY where there are
critical gaps in programs and
services that can improve the
behavioral health and mental
well-being of individuals and
communities.
6.
ELIMINATE behavioral health
inequities in access to and
quality of public behavioral
health services.
7.
INCREASE the emphasis upon
behavioral health prevention and
early intervention strategies.
4.
INFORM funding and policies
to address those gaps.
8.
CREATE strategies to help
address the social determinants
of behavioral health which are
exacerbated by racism, such as
inadequate housing, employment,
education, and elevated risk for
justice involvement.
5.
IMPROVE timely access to high
quality, effective community-
based services based on
both research-defined and
community-defined evidence.
2.
IMPROVE communication
and collaboration between
ACBH and the communities
it serves.
Alameda County Behavioral Health (ACBH) Strategic Plan10
Methodology
Alameda County Behavioral Health (ACBH) partnered with the
California Institute of Behavioral Health Solutions (CIBHS) to develop a
comprehensive, system-wide strategic plan. The Equity and Wellness
Institute (EqWI) and Adèle James Consulting were contracted to provide
organizational consultation to support this effort. To demonstrate
ACBH’s commitment to collective health and equity through an inclusive
process, it spearheaded a research project to review existing materials
and obtain feedback from various community groups, key community
members, organizations, and agencies regarding behavioral health care
delivery across the county. These findings were analyzed into themes
and strategic directions (Section VI) that informed the development of
this strategic plan.
A community-centered approach was used during data collection to
promote equity and strengthen the voices of community members and
service providers whose perspectives have been systematically excluded
from the behavioral healthcare system. ACBH used a community-based
information-gathering approach to:
> Strengthen ACBH’s connection with communities facing the
greatest inequities.
> Improve communication and collaboration with existing clients.
> Identify gaps in programs and services.
> Emphasize behavioral health prevention and early intervention
strategies.
> Help create a new plan for ongoing quality improvement,
system redesign, and client-centered care.
IV.
Alameda County Behavioral Health (ACBH) Strategic Plan 11
Twenty-eight organizations and agencies participated in
the effort to implement a community-centered approach
to behavioral health care in Alameda County through
meetings, focus groups, and interviews. These discussions
were digitally recorded, transcribed, analyzed for themes,
and consolidated into a report. The results were then
summarized and presented to the community through
listening sessions and integrated into the strategic plan.
The consulting team supported participant recruitment,
analysis, and data dissemination through several phases:
a. Materials Review (Fall 2022)
During materials review, more than 10 internal and
external-facing documents, as well as more than 15 raw
data sets from the county were analyzed (see Appendix
A for a list of materials reviewed). This literature review
provided the basis for the initial themes, findings, and
recommendations.
b. Countywide Community-Based Information
Gathering
To center community voices, the consulting team
facilitated 14 inclusive focus groups, eight meetings
with community members, and 10 interviews with
elected officials and city staff. Eighteen interviews were
conducted with key community leaders and members.
This process occurred from March - September 2022.
Through the focus groups and interviews, several
communities facing the greatest inequities were
represented, including:
> Black/African American, Chinese, Filipino,
Korean, Indigenous/First Nation, Pacific Islander,
Latinx, Immigrant/Refugee, Individuals with Lived
Expertise, LGBTQIA2S+, Older Adults, Transitional
Age Youth, Unhoused Individuals, Individuals
with Substance Use Disorders (SUDs), Justice
Impacted Individuals, Family Members, Parents,
and Caregivers.
Additionally, there were five listening Sessions with Board
of Supervisors offices, Districts 1 to 5, as well
as Alameda County’s City Managers. See Appendix B for
Sample Documents for Data Collection.
Qualitative Data Analysis
The focus groups and interviews from the
community gathering efforts were recorded, transcribed,
and analyzed. The analysis led to the development
of emergent themes and strategic directions
(recommendations). It was an iterative process that
included continuous data analysis and integration.
Ongoing Review with Internal ACBH
Staff to Refine and Finalize Themes and
Recommendations (April 2022 - May 2023)
Feedback on the Themes and Recommendations was
gathered from all levels of staff within ACBH, including
Clerical, Clinical, Middle Management, Executive, and
Senior Executive Leadership, through meetings to
gain their perspectives on the strengths, weaknesses,
opportunities and threats. ACBH and the consulting team
met once a week from April 2023 through Summer 2023
to develop and refine themes and recommendations
based on the ACBH staff feedback.
Listening Sessions (July 2023)
> ACBH and the consulting team held four public
listening sessions to disseminate findings to
community members and elicited feedback.
Alameda County Behavioral Health (ACBH) Strategic Plan12
ACBH Commitment
to Anti-Racism
At ACBH, we are fully committed to creating and maintaining an anti-
racist system. That starts with an acknowledgment that government
services at all levels have historically favored the rights of some of its
communities over others, and those inequities have left a legacy that
continues to this day. By acknowledging this reality, we task ourselves
with diligently investigating current practices, policies, and programs.
We use the full capacity of our system and its resources to identify,
understand, and rectify or reverse the longstanding, preventable,
and unfair outcomes, without excuse or hesitation. We take seriously
uncovered concerns and work proactively in collaboration with our
communities facing the greatest inequities to prevent future harms.
ACBH is jointly building a behavioral health system that meets the
needs of every individual in our county; no cultural, demographic, or
socioeconomic feature will predict their outcome. Our goal is to buck
the disheartening trend of systemic racism and other oppressions that
we all have inherited.
As we strive to create processes and systems that are rooted in diversity,
equity, inclusion, and justice, we commit to using language that
highlights the systems that contribute to the disproportionate impact
it has on certain groups. We also are cognizant of language and its
ongoing evolution, and intend to continue using inclusive language as
a simple and constructive way to approach new concepts with humility
and empathy. See the CDC’s Gateway to Health Communications for
additional suggestions on evolving language usage.
V.
Alameda County Behavioral Health (ACBH) Strategic Plan 13
Themes &
Strategic Directions
The Themes and Strategic
Directions presented in this
section result from almost two
years of meetings, research,
and analysis to provide clear
direction on ACBH areas of
focus to create more equitable
behavioral health services. The
processes used to gather this
information were community-
centered and included ongoing
feedback from ACBH staff.
The following themes include
“strategic directions,” which are
essentially recommendations
for implementable ideas that
address the themes. Strategic
directions describe how ACBH
plans to systematically move
forward while leveraging
community members’ lived
experience and expertise for
more equitable and integrated
behavioral health services. The
themes include the following:
VI.
1. Access – Establish strategies that are co-designed with
the community to advance equity, access, and cross-agency
collaboration.
2. Community Expertise – Uplift community assets for
policy/program development.
3. Housing – Collaborate with community partners to
increase employment for people who are or at risk of
homelessness with serious mental illness and/or substance
use disorders.
4. Programs – Evaluate and improve programs and services
so they are whole-person focused, culturally relevant, and
outcome driven.
7. Acceptable and Equitable Distribution of Funds for MH/SUD Needs – Ensure funding throughout
the whole system that serves people with co-occurring
conditions.
5. Equitable Care – Increase equitable care for
communities facing the greatest inequities through outreach,
recruitment, and programs – opportunities for improvement
persist especially for diverse Asian, Black, and LGBTQIA2S+
communities.
6. Re-entry and Criminal Justice – Increase
collaboration and coordination between ACBH and the Offices
of the Public Defender, District Attorney, Probation, Sheriff,
and the Collaborative Courts to ensure that Black men are
considered for behavioral health treatment as an alternative
to sending them to jail/prison.
Alameda County Behavioral Health (ACBH) Strategic Plan14
Alameda County Behavioral Health (ACBH) Strategic Plan 15
Establish strategies that are co-designed with the
community to advance equity, access, and cross-agency
collaboration.
THEME 1: Access
RECOMMENDATION 1.1
Continue to invest in improvement in ACBH’s ACCESS Program through co-design strategies
with communities facing the greatest systemic inequities.
“ACBH needs to build out its infrastructure to have more meaningful interactions with the community
and to really think through how to engage the community, share power, co-create, and make decisions
together. Inclusion is a good first step but not enough. They need to think through their structures to
create spaces for meaningful engagement.”
ACBH needs to confront behavioral healthcare barriers to support Alameda County residents in receiving quality and
equitable care, including for those in need of critical and immediate care. ACBH’s ACCESS Program (Acute Crisis Care
and Evaluation for Systemwide Services - 1-800-491-9099) is a beneficial initiative the department will uplift to support
behavioral healthcare recipients in navigating the system. ACBH has already invested time and resources in quality
improvement efforts to enhance ACCESS in order to make entry into services easier for community members. In
order to continue this work and most effectively meet the needs of the County’s diverse population through ACCESS,
the department may utilize collaborative approaches – like co-design – to engage community members as equal
collaborators to build trust and further improvements.
ACBH is committed to providing high-quality behavioral health services by targeting barriers to access.
The department understands that reliable sources for care, coverage, and culturally responsive providers
increase access to services and positive behavioral health outcomes. Community engagement is essential
for the department to cultivate a behavioral health system where people can quickly identify resources
and meet their needs. In addition, ACBH’s quality improvement practices for people from communities
that have been marginalized will increase cross-agency collaboration, advance equity, and improve the
health care system for everyone. Moreover, ACBH plans to support investment in communities facing the
greatest systemic inequities by implementing strategies that will increase culturally responsive outreach
and engagement in all improvement plans.
Alameda County Behavioral Health (ACBH) Strategic Plan16
RECOMMENDATION 1.2
To aid accessibility to care, increase culturally appropriate outreach and engagement. Partner
with community organizations that have trusted relationships with communities facing the
greatest systemic inequities to more effectively do outreach to and engage with people who
cannot access care.
“[Provide] training and education for CBOs — let them know all that is happening. Do more community
outreach. Partner more with community organizations.”
ACBH has connections with many community-based organizations (CBOs) that serve populations who have been
marginalized and seeks to strengthen these relationships by continuing to learn from and expand its understanding of
the communities served. Since ACBH is particularly concerned about behavioral health inequities, leveraging existing
partnerships could expand outreach to better support those who experience challenges in behavioral healthcare.
ACBH’s key strategy is to implement continual engagement and culturally responsive communication. Partnering with
CBOs that have strong relationships with communities facing the most significant inequities will offer crucial insight and
lead to innovative solutions that reduce barriers to access.
ACBH may use the co-design process to improve behavioral health service quality. A behavioral health care system that
prioritizes collaboration embraces everyone within the service provider’s sphere of influence, especially those most
affected by health inequities. This also includes formal training of behavioral health providers who have lived expertise.
ACBH is equipped to utilize co-design approaches by distributing feedback surveys and increasing the number of public
events where the department can be included in discussions with the public collective. This approach allows for a
feedback loop where community input is integral to ensuring infrastructure – like ACCESS – is continually updated. Staff
will collect feedback to learn how services can be more easily accessed, navigated, and be culturally competent. They
will then work to integrate these recommendations based on evidence of what works to support community health.
The co-design process also will allow the community to provide invaluable input and highlight barriers to access that
may be unknown to policymakers. By continuously emphasizing the importance of agency/client/and family member
partnerships and investing resources to support co-design strategies in under-resourced neighborhoods, ACBH plans to
cultivate a sense of community and trust that includes the department as a reliable source for behavioral healthcare.
Alameda County Behavioral Health (ACBH) Strategic Plan 17
RECOMMENDATION 1.3
Communicate improvement plans for inequities in access to the community; include visually
accessible data and social media as communication strategies.
“It’s important to hear from people that are of the community and working with the community.”
ACBH strives to maximize its capacity to more effectively engage and communicate with communities facing the
most inequities. Successful communication strategies include media outreach, information campaigns, branding, and
community engagement. Such strategies require a continuous community feedback loop to ensure ACBH understands
what materials and outreach best reach specific populations, and are culturally relevant.
One strategy ACBH may implement is the use of Public Health Communicators (PHCs) to share improvement goals for
healthcare access. PHCs are a collective of public health offices and specialists in social media, branding, and cross-
cultural collaboration. According to the National Association of County and City Health Officials (NACCHO), PHCs are
highly effective and a major asset to agencies like ACBH because they specialize in creating, distributing, and analyzing
public health messages. PHCs will strengthen ACBH’s virtual information distribution system by making accessible
content and increasing transparency about improvement plans.
Alameda County Behavioral Health (ACBH) Strategic Plan18
Alameda County Behavioral Health (ACBH) Strategic Plan 19
Uplift community assets for policy/program development.
THEME 2: Community Expertise
A key finding from the research gathered for this plan is the need for community expertise in establishing
best practices for culturally responsive behavioral health care. According to Alameda County for Fair
Redistricting, Alameda County is the fourth most diverse county in the nation. Incorporating community
expertise requires continuous and intentional collaboration to ensure that ACBH can meet Alameda
County’s diverse behavioral health needs.
ACBH is privy to effective community organizing approaches. As a department committed to removing barriers to
behavioral healthcare, ACBH could uplift all community assets to improve health in Alameda County through (but not
limited to):
> Local residents – their skills, experiences, passions, capacities, and willingness to contribute to the project.
Special attention is paid to those who experience systematic marginalization.
> Local voluntary associations, clubs, and networks – such as the athletic, cultural, social, and faith-based groups.
> Local institutions – public institutions such as schools, libraries, parks, and police stations, along with local
businesses and nonprofits.
> Physical assets – such as the land, the buildings, the infrastructure, and transportation.
> Economic assets – what people produce and consume, businesses, informal economic exchanges, and barter
relationships.
Recognizing that community assets improve the abilities and capacities of residents, ACBH can encourage community
resources for policy and program development. ACBH recognizes that there may be broad sweeping changes to the
Mental Health Services Act in 2024, and plans to continue with an inclusive stakeholder engagement process to help
shape the evolution of behavioral health services and support for Alameda County.
Alameda County Behavioral Health (ACBH) Strategic Plan20
RECOMMENDATION 2.1
Increase investment in community-defined evidence-based practices (CDEPs).
Community-Defined Evidence-Based Practices (CDEPs) are a set of practices residents have used to produce positive
outcomes. Such practices are not necessarily informed by empirical research, but are accepted by the community.
Menzies and Lavalle (2014) describe CDEPs as:
“...a set of practices that communities have used and determined by community consensus over time and
which may or may not have been measured empirically but have reached a level of acceptance by the
community.”1 A healing practice that has been used for centuries or even millennia is also a reasonable
example of empirical evidence. For example, Native Americans were practicing population health,
cognitive behavioral therapy, and group therapy (talking circles) for hundreds of years before it was
discovered by Western medical model practitioners.2
ACBH can proceed with CDEPs to learn where the community wants support and what process/outcome metrics matter
to them. ACBH’s commitment to CDEPs is informed by discussions with community members.
“Use more community defined programs that have shown great success to serve the community it was
designed to serve. [Current programs] do not have the data to move up from grassroots into promising
practice. [Community defined programs] work. They have greater participation, greater follow-through,
folks can relate to [them and it] includes people who have lived experience to conduct the work.”
ACBH may implement the following procedures:
> Ensure that CBOs have input into the kind of CDEP data they want with transparent access, and an agreed
upon, appropriate format. ACBH can then produce culturally appropriate infographics, a quarterly report, and a
dashboard where the public can ask questions and receive feedback.
> Based on what is currently available and with community input, the department will assess how to develop
new consistent and real-time data collection to determine ongoing unmet needs, especially in communities
facing the most disparities. This is an effective strategy for understanding how to define these practices.
> Research and understand new methods for CDEPs, such as Addressing Disparities in Behavioral Health for
Communities of Color: The Community Defined Evidence Project.
1 Mental Health Disparities by Race and Ethnicity for Adults in Medi-Cal. https://www.chcf.org/publication/mental-health-disparities-race-ethnicity-adults-
medi-cal/#related-links-and-downloads. Authored by the California Pan-Ethnic Health Network and published by the California Health Care Foundation.
2 Menzies, P., & Lavallee, L. (2014). Preface. In P. Menzies, & L. Lavallee (Eds.), Journey to healing Aboriginal people with addiction and mental health issues:
What health, social service and justice workers need to know (pp. xi-xiii). Toronto, Canada: Centre for Addiction and Mental Health. xxv AND Tucker, R. P.,
Wingate, L. R., & O’Keefe, V. M. (2016). Historical loss thinking and symptoms of depression are influenced by ethnic experience in American Indian college
students. Cultural Diversity and Ethnic Minority Psychology, 22(3), 350-358. https://dx.doi.org/ 10.1037/cdp0000055
Alameda County Behavioral Health (ACBH) Strategic Plan 21
Ongoing and supplemental funding for community partners is essential to CDEPs. For instance: California’s Department
of Health Care Services recently issued an RFP specifically on this topic: Evidence-Based Practices and Community-
Defined Evidence Practices Grant Program:
In line with its legislative mandate, DHCS will distribute $429 million in grants to organizations seeking
to scale evidence based and/or community-defined evidence practices (EBPs/CDEPs) that improve
youth behavioral health (BH) based on robust evidence for effectiveness, impact on racial equity, and
sustainability.
ACBH also spoke with a significant number of community members who recommended the need for workforce
development training programs and finding sufficient resources to hire and develop more staff who are representative
of the communities systematically excluded from the behavioral health care system.
RECOMMENDATION 2.2
Create formalized structures for Community Defined Evidence-Based Practice (CDEP)
providers to share learnings with ACBH and further develop these clinical practices.
“Today, structural racism has resulted in the exclusion of behavioral health interventions developed and
tested by and for BIPOC and LGBTQIA2S+ communities’ health and wellbeing.”
(Policy Options for Community-Defined Evidence Practices)
ACBH could co-design Behavioral Health Learning Communities with Asian, Black, and LGBTQIA2S+ communities.
This would require extensive efforts and investments in research, practices, and policies that are currently impacting
specific communities experiencing poor behavioral health outcomes. Participating in organized learning sessions and
focus groups will provide uninterrupted collaborative space to develop engagement and share learnings to incorporate
evidence-based learning into their practice.
ACBH may establish new and ongoing relationships with CDEP providers to gather data and best practices. This may
include regular meetings between ACBH partners and CDEP providers to set expectations and ongoing learning
communities between the two parties. This necessary collaboration will give insight into the system that often overlooks
race, racism, sexual orientation, or the history of legalized discrimination against BIPOC and LGBTQIA2S+ communities
(Policy Options for Community-Defined Evidence Practices). ACBH could create a Task Force that includes participants
from the Behavioral Health Learning Communities to focus on communities facing the greatest inequities.
“There are people that we can’t serve. There’s too many guidelines to enroll individuals. We have to ask
permission to see people. [We need] reengineering of the system. ACBH is good at what it does, but it
needs to trust CBOs to do what they do best.”
Alameda County Behavioral Health (ACBH) Strategic Plan22
RECOMMENDATION 2.3
Increase transparency and communication about how the community is making a difference
by driving changes in ACBH.
ACBH has identified measures to ensure the department is accountable for the overarching goals of the Strategic Plan
and has designed the recommendations for this section to measure how well it is upholding principles of community
engagement and culturally responsive care.
The first step to ensure accountability is a continuous and transparent conversation with residents. A robust feedback
loop is an effective and empowering strategy to leverage community expertise. In this process, residents learn how
they are driving changes in the department because they have opportunities to share their behavioral healthcare needs
and receive status updates. In addition to direct engagement with community members, ACBH will also strengthen
partnerships with CBOs to develop best practices to service populations experiencing disproportionate barriers to
healthcare. ACBH may:
> Increase accountability to the community by improving communication and transparency regarding how
feedback is being incorporated into the programs.
> Connect and highlight the impactful work that CBOs are doing in the community by publicly sharing best
practices and accomplishments.
> Hold quarterly community forums with designated ACBH staff to provide the community with updates.
RECOMMENDATION 2.4
Hire people at ACBH who are members of the priority population or those who have
successfully discharged from programs (e.g., formerly incarcerated, homeless) in the design
and implementation of all services provided by ACBH and our partners.
“We are doing leadership development in the community but can’t give them tasks to do with our agency
because they are moms, family members. I wish we could compensate for their time and effort to be advocates.
We build leadership capacity, but then we can’t support them in their journey with the work they do.”
ACBH can create internal structures and processes to allow broader hiring criteria with professional training
opportunities for priority populations, such as a Persons with Lived Expertise cohort that will work in tandem with the
department to support a continuum of care. This approach will allow their lived and often intersectional experiences
and expertise with behavioral health (as well as incarceration and homelessness) to better inform ACBH services.
This also may include increased funding for recruiting, hiring, and training staff from priority populations, as well
as accessing funding specifically allocated for workforce development within the agency to support the hiring of
community health and outreach workers.
“Having people with lived experience and having a racial match is important. There is a lot of evidence
that it makes a difference. If you see someone of your own race you are far more likely to trust them and
follow through with care. Community workers can help with that.”
Alameda County Behavioral Health (ACBH) Strategic Plan 23
Alameda County Behavioral Health (ACBH) Strategic Plan24
Collaborate with community partners to increase
employment for people with serious mental illness and/or
substance use and addictive disorders who are unsheltered
or in supportive housing.
THEME 3: Housing
People who are unhoused experience behavioral health disorders at higher rates and have unique
treatment challenges. The COVID-19 pandemic also exacerbated these disparities. Homelessness in
Alameda County has increased 22 percent since 2020. The county’s estimated population of people
experiencing homelessness with SMIs or SUDS is 10,000. It is important to note that although behavioral
health disorders are present in the unhoused community, recent research has found that behavioral
health disorders are more frequently an outcome of being homeless and not a cause. The cost of housing
is the primary contributor to homelessness.
Although ACBH receives funding to address housing needs, this funding is dedicated to Office of Homeless Care and
Coordination to improve clinical services to those who are unhoused with behavioral health disorders. ACBH may
increase employment opportunities for individuals experiencing Severe Mental Illness (SMIs), Substance Use Disorders
(SUDs) and who are unhoused. ACBH is also prepared to strengthen relationships with other organizations and agencies
engaged in employment efforts for the unhoused.
RECOMMENDATION 3.1
Partner with entities such as Alameda County Workforce Development Board to expand
effective supported employment programs, such as Individual Placement and Support (IPS),
for clients who are unhoused.
SMIs and SUDs significantly influence vocational outcomes, particularly for people experiencing homelessness. ACBH
intends to partner with Alameda County Workforce Development Board to expand the Individual Placement Support
(IPS) for people who are unhoused.
“I’m advocating for my son and the thousands of young adults who are wandering our streets, high on
drugs, not wanting to live, because there is no place for them. [They are] furthering their brain damage
and PTSD from all the violence they endure, and provoke. They are essentially un-housable when
untreated. They are jailed, and get no help in jail, they are crowded together, and get into fights.”
Alameda County Behavioral Health (ACBH) Strategic Plan 25
RECOMMENDATION 3.2
Support program design and implementation for Individual Placement and Support (IPS)
expansion by including former and current unhoused persons with lived expertise as well as
hired advocates.
“Make our clients the providers. Providers are the ones that speak and represent the community.”
ACBH is dedicated to integrating people with lived expertise, including family members, in their effort to overcome
behavioral health inequities and foster community health. Recognizing that internal processes should support the
inclusion of people with lived expertise, the agency will encourage individual and family participation in program design
and implementation for housing services. The Substance Abuse and Mental Health Administration provides guidelines
for the involvement of clients and their families in the design, development, and implementation of programs and
services. To cultivate involvement among people who have experienced homelessness as well as their loved ones, ACBH
may consider the following:
1. Reflecting the value of including persons with lived expertise and their families in ACBH’s mission statement.
2. Setting a criteria for their participation in program planning.
3. Providing training and staffing to include persons with lived expertise and their loved ones; existing staff will
receive coaching on peer and family-related issues.
4. Creating a consent form detailing the risk and benefits of the service to support recipients’ informed decision
making.
5. Inviting people with lived expertise and their families to participate in the design and support evaluation
activities.
The community members who participated in the research that informed this Strategic Plan emphasized the need
for hired advocates, specifically for situations involving unhoused people experiencing SMI or SUD. ACBH could use
culturally responsive guidelines to encourage people with lived expertise and their families to create a crisis response
team of hired advocates who can respond quickly to problems in the community.
Alameda County Behavioral Health (ACBH) Strategic Plan26
RECOMMENDATION 3.3
Engage transitional-age youth (TAY) and justice-impacted adults in discussions to better
understand the needs and barriers to employment which impacts housing.
“Make our clients the providers. Providers are the ones that speak and represent the community.”
To better support transitional-age youth (TAY) and justice-impacted adults with behavioral health issues, ACBH may
engage in ongoing discussions with this population to bolster existing employment services, such as IPS (evidence-
based programs for individuals with behavioral health issues). Supporting TAY and justice-impacted adults to learn
valuable skills may increase housing security through vocational initiatives.
Closer collaboration with TAY and justice-impacted adults would help ACBH grow its capacity to: 1) challenge and
maximize opportunities for entering the workforce; 2) organize systems of support that can be leveraged; and 3)
identify CBOs that provide workforce development and reentry services. Research findings indicated that the behavioral
health care-to-prison pipeline is a leading concern for the communities ACBH serves.
ACBH could provide TAY and justice-impacted people with specialized behavioral health support, so they can get the
services they need instead of getting trapped in cycles of poor health and incarceration. Conversations with these focus
populations may include, but are not limited to the following:
> Developing closer partnerships with school districts to determine the unique needs of youth in the priority
community.
> Providing relevant education and information around workforce development in schools and community
colleges.
> Identifying CBOs that provide youth and family supportive services to understand best practices and how to
access youth and adults who are especially at risk.
> Understanding the unique behavioral health challenges that people who are justice-impacted have with the
carceral system.
> Providing resources for existing workforce development programs for these populations.
Alameda County Behavioral Health (ACBH) Strategic Plan 27
Alameda County Behavioral Health (ACBH) Strategic Plan28
Evaluate and improve programs and services so they are
whole-person focused, culturally relevant, and outcome
driven.
THEME 4: Programs
ACBH would consider reducing barriers to healthcare access by integrating holistic approaches to
services. People receiving services from the department are not the only ones impacted by their
diagnoses. ACBH recognizes that the community is also affected, especially families and caregivers.
Loved ones should be included in behavioral health solutions. ACBH supports whole-person, culturally
responsive, outcome-driven care that addresses root causes, not just symptoms.
RECOMMENDATION 4.1
Use innovative strategies, such as hiring Community Health Workers (CHWs) or offering more
clinical training for providers to increase culturally responsive care and remove barriers to
healthcare in all communities.
“Get more bang for the buck with community health workers – people are more likely to engage with
them and share practical problems they need help solving.“
People from communities that are marginalized who need behavioral health services respond more readily to those
with similar cultures or personal history. The basic premise of culturally responsive care is that client diversity and
cultural factors influence behavioral healthcare. Providers unable to understand their positionality and how identities
shape clients’ experiences run the risk of compromising service delivery. The data gathered in this project reflected the
importance of culturally responsive care in improving behavioral health outcomes.
“One of key components to building trust in community work is visibility…and reflecting the culture of the
community.”
To bring on new staff with lived experience and community health workers and deepen the impact of the outreach,
updated hiring practices will require:
> Developing and deepening community connections and relationships by working directly with CBOs who are
serving these communities.
> Doing outreach to and recruitment with non-traditional partners such as local CBOs, the Black Chamber of
Commerce, the Hispanic Chamber of Commerce, as well as ethnic fraternities and sororities to increase the
candidate pool.
Alameda County Behavioral Health (ACBH) Strategic Plan 29
> Research how to integrate equitable practices into recruitment, hiring, onboarding, and staff evaluations,
which includes establishing career pathways to advance within the organization.
> Incorporating more equitable and inclusive hiring practices: create inclusive job descriptions and interview
questions that include an understanding of institutional or structural racism and bias and standardize the
interview process; reviewing minimum qualifications to include lived expertise, work samples, or on-the-job
learning rather than educational requirements.
The stigma and discrimination around behavioral health care is persistent. Outreach and recruitment efforts are
important for peer support specialists and community health workers in communities where negative ideas about SMI
and SUDs prevent people from getting the support they need. This approach requires cultivating quality relationships
with staff and the people served. Peer Support Specialists and Community Health Workers also may be able to provide
resources in the languages spoken, and ongoing access to resources specific to that community. Families and individuals
can have access to consistent and regular services that are tailored to their needs.
“Recruiting, developing and supporting training of additional Peer and Community Health Workers who
reflect the communities we serve is critical to providing high quality health services and reducing mental
health stigma.”
For instance, the Promotora model traditionally has been successful in reaching Hispanic/Latino communities. Aspects
of this model could be used successfully in other communities to build trust, gain access, and provide ongoing follow-
up. A definition of the Promotora model is as follows:
“A promotora is a Hispanic/Latino community member who receives specialized training to provide basic
health education in the community without being a professional health care worker.[1] While most of
their work entails educating target audiences about health issues affecting their community, they also
provide guidance in accessing community resources associated with health care. Often promotores are
residents and identified leaders in their community who work for community-based health promotion
projects or as part of a research group. Thus, promotores serve as liaisons between their community,
health professionals, and human and social service organizations. As liaisons, they often play the roles of
an advocate, educator, mentor, outreach worker, role model, and interpreter.1”
The Promotora Model could be expanded to different communities to provide appropriate language access, youth
and family engagement, community health education and prevention, educational workshops on behavioral health
and resources, free and accessible (+ongoing) behavioral health resources in various languages, and cultural healing
practices beyond westernized behavioral health approaches that work for BIPOC.
1 https://en.wikipedia.org/wiki/Promotora
Alameda County Behavioral Health (ACBH) Strategic Plan30
RECOMMENDATION 4.2
Create healthier communities by increasing whole-person care, prioritizing trauma-informed
cultural healing practices, and expanding families’ and caregivers’ roles in program policy,
design, and practice.
Whole-Person Care
As a public health agency concerned with barriers to healthcare access, ACBH providers would consider examining
multiple factors influencing behavioral health to provide whole-person care instead of treating only symptoms. Whole-
person care includes comprehending the trauma underlying behavioral health issues and substance use disorders. It
also includes embracing culturally responsive healing practices to meet clients where they are, prioritize their needs,
and address root causes instead of symptoms. By addressing whole-person care, behavioral healthcare systems,
families, and communities nurture the delicate equilibrium between mind, body, and spirit through evidence-based
conventional and complementary treatments and services. California’s Department of Health Care Services started
using this model in 2016.
Families and Caregivers
“The issue that isn’t being addressed is how to increase family involvement in the care of their loved ones
and safety for those families whose loved ones live with them. I add this both as a family member who
has been largely left out of consideration, while being, at the same time, the caregiver for my son. It is a
dream of mine to see family advocates embedded in the work of the case management teams.”
The family members and caregivers interviewed for this process shared a lack of understanding of or exclusion from
care plans. Although HIPAA laws exclude families from being directly involved in care, those receiving treatment could
choose to have family members or other caregivers involved. For those completing treatment, families can also receive
discharge orders.
ACBH understands that SMIs and SUDs are a challenging experience for both the person being treated and those in a
relationship with them. It is important to prioritize inclusive approaches to behavioral healthcare services that address
the needs of families and caregivers, such as family partnership programs. The goal of this approach is to address root-
cause trauma so people can live healthy lives.
Cultural Healing Practices
ACBH recognizes that the people it serves are embedded in varying social settings and experience unique challenges
based on their positionality. Incorporating cultural identity through traditional healing practices encourages community
integration and validates recipients’ livelihoods, supporting treatment for people experiencing access barriers to SUD
and SMI care. Holistic trauma-informed healing practices, such as in Native American communities, or in other non-
Western modalities will be referenced and integrated to support communities seeking holistic and alternative health
solutions. Some examples of these successful models include:
Alameda County Behavioral Health (ACBH) Strategic Plan 31
> Alameda County Care Care Connect
> California Association of Public Hospital and Health System
> Native American Health Center
The COVID-19 pandemic demonstrated the need for public healthcare systems, social service agencies, and CBOs to
work collaboratively to overcome barriers to behavioral healthcare. Collaboration with organizations and agencies using
whole-person care is essential for providing high-quality health services for everyone. ACBH could leverage existing
networks to develop a committee of providers who share the value of whole-person care.
RECOMMENDATION 4.3
Engage in community-based participatory research (CBPR) to understand the
unique cultural needs of ACBH programs and to solicit input as well as feedback
on how ACBH care is designed and delivered from the people being served.
“The solution lives closer to the need. Get the ideas from the people who need support.”
A key finding from conversations with community members was the increased need for input from the local population
to create culturally responsive services. The community-based participatory research (CBPR) model is an effective
accountability measure often used in public health scenarios. CBPR is a collaborative approach to examining behavioral
health needs.
The history of research is marked by community exploitation, particularly for groups experiencing systemic
marginalization. CBPR is designed to shift this paradigm by building trust between researchers and the community. In
this non-traditional research approach, community members engage as project facilitators and participants. ACBH plans
to expand its understanding of the unique cultural needs in Alameda County by engaging in CBPR with communities
facing the most significant inequities and will use this research approach to ensure it is held accountable for and receive
feedback on the items presented in this strategic plan.
Characteristics of a CBPR approach to behavioral health requires1:
> Recognition of the community as a unit of identity.
> Support for the strengths in the community.
> Collaborative partnerships developed in all phases of the research.
> The integration of knowledge and action for mutual benefit.
> Addressing health from a positive and ecological perspective.
1 The National Library of Medicine
Alameda County Behavioral Health (ACBH) Strategic Plan32
RECOMMENDATION 4.4
Build strong program evaluations that reflect communities’ values; engage the community in
co-designing meaningful outcome metrics.
An advantage of the CBPR process is that it helps identify community values to measure program outcomes. This
approach could be done in conjunction with co-design, including community members working alongside professional
researchers and evaluators who continually assess for quality improvement and best practices. Below is an example of
the process:
> After identifying the core group, local community partners, researchers, and evaluators embark on the co-
design process with the intent to create a feedback loop that is frequent and equitable.
> They meet with the population of interest to establish goals for the project, and as a result, the evaluation
metrics will be determined for what is considered a success and what is not.
> The team establishes a criteria for the metrics with the population of interest, which can be a core group or
focus groups.
As mentioned previously, promotores are Latinx community members who advocate for individuals and community
needs to ensure they receive the service they deserve. It is a bi-directional approach that ensures both parties are
supporting each other to create a robust and inclusive healthcare system for everyone. ACBH could use the promotores
model to engage community experts in all service and program efforts. For example, community experts will be in equal
partnership with ACBH and participate in research and evaluation of initiatives.
“A collective impact approach to service delivery will also be powerful, meaning that all service agencies
use the same measurement tools so that we can compare apples to apples and read the data in a
congruent way. What we measure is extremely important.”
This bidirectional approach includes flexibility around the implementation and evaluation process, especially in the
development of metrics. Projects that do not meet community expectations and values will need to be re-evaluated for
funding.
Alameda County Behavioral Health (ACBH) Strategic Plan 33
Alameda County Behavioral Health (ACBH) Strategic Plan34
Increase equitable care for communities facing the greatest
inequities through outreach, recruitment and programs –
opportunities for improvement persist especially for diverse
Asian, Black, and LGBTQIA2S+ communities.
THEME 5: Equitable Care
The research conducted during this project indicated that many diverse communities within Alameda
County face substantial inequities when it comes to equitable behavioral healthcare. As mentioned
above in Recommendation 4.1, creating trust through outreach is a critical first step to addressing and
shifting systems of care. Culturally competent outreach, recruitment of community health workers, CBO
partnerships, and deepening connections with individuals representative of the communities most impacted
will support shifting the system to a more equitable one.
RECOMMENDATION 5.1
Increase effective outreach and engagement about services to diverse Asian, Black (especially
men) and LGBTQIA2S+ communities, particularly intersectional communities, using traditional
and non-traditional media sources as well as word of mouth.
The challenges experienced by communities reporting the most inequities are intersectional — they cross many
boundaries with a variety of issues related to work, health, and access to care. For instance, members of the
LGBTQIA2S+ community interviewed for this plan shared that ACBH’s services are not meeting their needs. Their lack
of participation speaks to the trans-gender communities’ lack of trust in the behavioral health care system1. Other
members of the broader LGBTQIA2S+ community also mentioned feeling that the system was especially transphobic,
and that cultural sensitivities related to issues with gender/sex/race/sexuality identity have not been fully considered.
It is important to improve relationships with the transgender community and reduce barriers experienced by this
population. Current programs that could be expanded upon or learned from include the following: Side by Side (serving
Queer youth), The Pacific Center for Human Growth, and the East Bay Queer Arts Center.
“All decisions need to be viewed through an equity lens. Equity needs to be a North Star and embedded
in all policies. Shape processes and tools to consistently assess for equity. Determine how to measure for
equity. What are the metrics? Diversity in workforce, diversity in clients, etc. Consider sites across the
country to get ideas around metrics.”
1 Protecting and Advancing Health Care for Transgender Adult Communities
Alameda County Behavioral Health (ACBH) Strategic Plan 35
Other community-based suggestions to address this recommendation included getting the right qualified people on the
ground to model equitable clinical interventions:
> Put clients with lived experience into direct outreach coordination, and counseling roles to better represent
the diversity of their communities and similar lived experiences. They would require training, for example
investment in a course such as the Lay Counselors Academy, which teaches basic counseling skills to non-
licensed health care staff so they can be appropriately paid.
> Since transgender individuals’ experiences are incredibly diverse, new approaches to meet their needs could
include identifying trans researchers involved in community engagement.
> Recruit more Black clinical social workers and therapists to directly serve their communities.
> Provide culturally appropriate and competent educational resources and opportunities to the AAPI community.
> Develop recruitment strategies to increase and retain behavioral health workers with lived expertise by
examining best practices.
“Several [people] I spoke to addressed systemic and structural racism and the need to have more Black
therapists and psychiatrists who had some likelihood of shared racial experiences.”
Creative methods for outreach, recruitment, and implementation to more effectively reach these communities can
originate from a grassroots level and in collaboration with ACBH, much like the Promotora model mentioned above.
This could include, but not be limited to: providing more language access, youth and family engagement, community
health education and prevention, educational workshops on behavioral health and already existing resources and
best practices; free and accessible (+ongoing) behavioral health resources in various languages, and cultural healing
practices beyond westernized behavioral health approaches that work for BIPOC and trauma-informed resources.
Because there is a dearth of resources specifically for the Black community when it comes to behavioral health services
(many ending up in prison or jail instead of receiving appropriate treatment), it was suggested to create cultural centers
where they can gather and receive behavioral health support and resources. Other ways to do effective outreach
include promoting services in cultural community hubs and businesses that might serve these communities like
hospitals, schools, housing services, welfare, and social services.
Alameda County Behavioral Health (ACBH) Strategic Plan36
RECOMMENDATION 5.2
Increase the number and quality of supportive and specialized programs for diverse Asian,
Black, and LGBTQIA2S+ communities, particularly youth.
To more effectively meet the needs of these diverse populations, the following activities could take place to increase the
quality of supportive and specialized programs:
> Build a database of current, effective and specialized programs and develop relationships with key leaders to
glean information that can be shared with existing, known programs.
> Research successful programs and best practices for these groups. For instance, the California Reducing
Disparities Project has specific models and programs that directly work with African-American, API,
LGBTQIA2S+, LatinX and Native American populations. Additionally, evidence-based youth research can be
found in DHCS’s Evidence-Based Practices and Community-Defined Evidence Practices Grant.
> Develop new partnerships with these types of CBOs to integrate best practices into known programs and as
part of their funding criteria, and make these resources widely available at DHCS as well.
> Make it easier for CBOs to access funding that can support and expand these services by hiring additional peer
workers, as well as streamlining government grant processes, and accessing private foundation funding.
RECOMMENDATION 5.3
Ensure CBOs with positive evaluations of their clinical community defined practices
are integrated into the system of care as true partners; leverage CBO presence to build
community trust.
Social support is vital to behavioral change. ACBH is incentivized to ensure that care plans extend from behavioral
healthcare settings to the recipient’s community. Partnering with CBOs to integrate clinical community-defined
practices into ACBH’s system supports the success of care plans. Additionally, this approach addresses the healthcare
recipient’s social needs, which are typically overlooked. Although CBOs are highly valued and trusted organizations in
communities because they have easier access to community members outside of clinical settings, they can be untapped
resources in the behavioral healthcare system.
ACBH may strategically include CBOs that provide social services to residents in care plans, particularly for recipients
most affected by health inequities. The intent of this approach is to leverage CBO relationships to reduce the dominant
cultural and personal stigmas associated with behavioral healthcare. Collaborations with CBOs will reduce the financial
burdens associated with delayed behavioral healthcare, resulting in effective and culturally responsive care plans, and
better health in Alameda County.
Alameda County Behavioral Health (ACBH) Strategic Plan 37
RECOMMENDATION 5.4
Ensure staff serving LGBTQIA2S+ communities receive cultural humility and culturally
responsive training to be equipped with the tools, terms, and understanding to provide
compassionate, inclusive, and equitable care.
Based on successful models mentioned above in 5.1 and 5.2 (and the resource below), customize existing training
programs specific to ACBH staff, like ONTRACK Program Resources Training, to address cultural humility and
responsiveness and break down stigmas and stereotypes of people with whom they have direct contact.
> Leverage current available resources like ONTRACK with other successful training programs, such as the
Community Mental Health Equity Project (CMHEP). They provide county behavioral health departments and
community-based organizations access to no-cost training opportunities, technical assistance, and resources.
> In addition, California’s Department of Social Services (CDSS) has a Sexual Orientation, Gender Identity, and
Expression (SOGIE) webpage that provides more information and resources to support cultural responsiveness.
The LGBTQ Navigating Home Program (found on the SOGIE webpage) is also an additional resource to support
child welfare workers and departments working with LGBTQIA2S+ children and youth and their families who
are in foster care or are at risk of entering care.
Alameda County Behavioral Health (ACBH) Strategic Plan38
Alameda County Behavioral Health (ACBH) Strategic Plan 39
Increase collaboration and coordination between ACBH
and the Offices of the Public Defender, District Attorney,
Probation, Sheriff, and the Collaborative Courts to ensure
that Black men are considered for mental health treatment
as an alternative to sending them to jail/prison.
THEME 6: Re-entry and Criminal Justice
“Today’s prisons and jails have replaced hospitals as the primary providers of inpatient
psychiatric care.”
Alameda County is experiencing challenges within the behavioral health system that have worsened since the
Lanterman Act of 1971, which deinstitutionalized people experiencing serious mental illness (SMIs) from mental health
facilities. During the first year of the Lanterman Act, the number of individuals entering the criminal justice system with
SMI doubled. People from systematically disadvantaged groups suffered the most from this law, especially Black men.
Jails and prisons across the country hold more people experiencing SMI than the largest remaining state hospital.
Contemporary issues in the criminal justice system intersect with social inequities and the behavioral healthcare system.
According to the Alameda County Mental Health Advisory Board, 22% of people in Santa Rita Jail are diagnosed with
SMI. Black Americans are imprisoned at five times the rate of White Americans. Black men experience the highest
incarceration rates and are more likely to experience severe hardship in prison, including solitary confinement and
inadequate behavioral health treatment. Contemporary SMI challenges also intersect with homelessness and the
criminal justice system. These realities highlight deeply rooted bias within social institutions in the United States.
“It is more common for people of color to go to Santa Rita Jail and for white people to go to John George
[Psychiatric Hospital]. As a result, people of color never even get into the system of [behavioral health]
care. This problem becomes compounded by implicit bias of law enforcement. Once an individual goes to
Santa Rita Jail, there is no pipeline from the jail to John George.”
Alameda County Behavioral Health (ACBH) Strategic Plan40
RECOMMENDATION 6.1
Create a Task Force led by ACBH that includes people with lived expertise and communities
that are justice-impacted as well as Offices of the Police Department, District Attorney,
Probation, Sheriff, and the Collaborative Courts to create a shared vision and intended
outcomes for the implementation of the Care Act in Alameda County and to ensure Black men
are considered for mental health treatment as an alternative to incarceration.
Although there is current collaboration between some agencies to address the intersection of behavioral health
and incarceration, it’s critical to have communities most impacted and with lived expertise at the table. It would be
beneficial for ACBH to conduct outreach with other CBOs serving these communities as well as others in the criminal
justice system who have direct contact with people who are justice-impacted – including those incarcerated, in reentry,
or families and friends of those who are incarcerated. To best understand the needs of this population, ACBH can
ensure they also have a leadership role in the task force.
Additionally, Alameda County’s probation department works with many CBOs to provide supportive services in areas
like housing, employment, family relationships, education, and substance abuse treatment, as well as funds to assist
with paying for rent, food, and transportation. The county also provides a reentry resource directory, as well as a
reentry court that accepts people on parole (from state prison) or probation who are violating (or are at risk to violate)
the terms of their supervision due to addiction or co-occurring conditions.
ACBH is already actively involved with Alameda County’s Mental Health Advisory Task Force (MHAB)/ Criminal Justice
Committee. Their 2020-2021 Annual Report mentions a focus on the conditions for mentally ill people incarcerated at
Santa Rita Jail, increased opportunities for diverting defendants out of the criminal justice system and into the medically
appropriate level of community-based behavioral health treatment, and the need for better discharge planning when
defendants leave Santa Rita Jail and/or John George Psychiatric Hospital and re-enter the community.
Creating a new Task Force (or expanding the current one) could create a better understanding between the agencies
about the role of behavioral health services versus what is offered in the criminal justice system (with limited behavioral
health services), and address policies and procedures so those in the system get the care they need instead of the
revolving jail door. This task force could also address ways to prevent people from going to jail in the first place, as well
as increase opportunities to provide programming that helps to address mental health and trauma inside. It could also
provide a list of reentry services to support those returning to their communities.
On June 17, 2021, MHAB strongly supported the “Care First, Jail Last” Resolution and urged the Board of Supervisors
to reallocate half of the money previously earmarked for Santa Rita Jail and approve it instead for community-based
treatment and housing that will reduce the number of mentally ill people who are incarcerated.
This Task Force could also be leveraged to assist with the visioning for ACBH’s implementation of the Community
Assistance, Recovery, and Empowerment (CARE) Act.
Alameda County Behavioral Health (ACBH) Strategic Plan 41
RECOMMENDATION 6.2
Work with organizations to increase the number of people with lived expertise helping design
jail behavioral health and re-entry services, including warm “hand-offs” for people leaving
prison or jail.
Most prisons and jails have very limited staff to support people living inside with mental and behavioral health issues.
One of the answers to providing supportive rehabilitative and trauma-informed services is to bring successful programs
inside the carceral system in order to fill that gap and create a continuum of care from the inside out. Although there
is already a reentry network of support for people who are returning citizens to Alameda County, there are fewer
continuum-of-care resources for those incarcerated in Santa Rita Jail.
Less rehabilitative or trauma-informed programming is available in the county’s jail system than in the state prison
system, and since jails are a revolving door for people with ongoing SMIs, the communities most deeply impacted must
have a seat at the table. People from these communities – who have lived expertise or are justice-impacted – know
the most effective ways to support those who are justice-involved. This also takes away the paternalistic approach to
“telling” people what they need versus facilitating their growth and healing. Moving away from that approach into a
model where more people with lived expertise have input into in-jail and post-release programming is critical.
The Task Force listed in Recommendation 6.1 could be one way to connect the different agencies and CBOs so actual
needs inside can be determined, and programs can be developed that meet those needs. Additionally, by collaborating
with the different agencies, new policies and procedures for allowing CBO-based programs into the jail could be
streamlined to make it easier for people to receive the mental and behavioral health services they need.
For the Black community, it also was mentioned that men need a culturally congruent system in place to support
them with their behavioral health needs and would benefit from having access to places that understand and have
experience with Black culture.
CBO’s in collaboration with the carceral systems could also work to develop more effective ways to do “warm handoffs”
– meeting people at the gate when they leave jail and ensuring they get the services they need and appropriate
community connection in a continuum of care. Rather than people just ending up back on the streets, programs that
offer these transition services within the first 48-72 hours are critical to stopping this revolving door. These types
of programs, which are often community-based, are critical to supporting successful reentry so returning citizens’
behavioral health needs are met.
Alameda County Behavioral Health (ACBH) Strategic Plan42
Alameda County Behavioral Health (ACBH) Strategic Plan 43
Ensure funding throughout the whole system that serves
people with co-occurring conditions.
THEME 7: Acceptable and Equitable Distribution of Funds for MH/SUD Needs
People with mental health and substance use co-occurring disorders simultaneously require bi-directional
coordinated treatment and collaborative actions between providers. ACBH recognizes the challenges
experienced by people with co-occurring disorders and has designated funding for reducing barriers to
healthcare access in this population. The department could cultivate new partnerships and strengthen
existing ones within the service system to develop institutional programs and policy initiatives. If SB 326
passes, ACBH will be in a position to use Mental Health Services Act funding on substance use disorders
and can use this flexibility to increase equity in funding between these two systems. In addition, ACBH can
deepen its relationship with local CBOs and the county Medicaid Managed Care Plan, the Alameda Alliance
for Health, to address mild-moderate/SMI/SUD referral needs and utilize evaluation metrics to improve
service quality.
“What we are asking for is expensive, but what is more expensive is doing things that don’t work.Crisis
services are the most costly. Act sooner to prevent crisis and the lifelong deterioration that results from
not treating early in the course of the illness.”
RECOMMENDATION 7.1
Increase partnerships with institutions addressing intersectional issues, such as Medi-
Cal Managed Care, the Courts, and the District Attorney’s office, to integrate and create
intersectional funding for substance use disorders and mental health.
By pooling resources and partnering with other institutions, ACBH could increase funding to support people with
intersecting behavioral health needs. The initial impetus for more coordination between ACBH and institutions comes
from the movement to replace long-term psychiatric facilities with community health facilities for individuals less
dependent on mental health care. The department acknowledges the unintended consequences of this change.
An increasing number of people with MH and SUDs do not seek help from social service institutions because their
behavior or state of mind can be misunderstood and judged by staff. ACBH may strengthen relationships with their local
Medi-Cal Managed Care Plan, the Alameda Alliance for Health, the courts, and the DA’s office to create a wraparound
Alameda County Behavioral Health (ACBH) Strategic Plan44
process with the capacity to support people with co-occurring conditions and ensure they receive the appropriate
behavioral health care through the continuum of care.
We need to partner at a high level and include Public Health and the Municipalities to braid funding
instead of looking for how to bill all services through MediCal funding.
RECOMMENDATION 7.2
Create opportunities for structured dialogue between MH and SUD agencies about
programmatic and policy strategies to improve care for co-occurring conditions.
“Cross-system referrals increased and this was very beneficial. The more that the county pushes cross-
system collaboration and funds it, the better this will work.”
Behavioral healthcare needs are complex, particularly for individuals experiencing co-occurring conditions. Thus, ACBH
can create opportunities for bi-directional communication between MH and SUD agencies to discuss programmatic
and policy strategies to assist individuals impacted by co-occurring disorders. ACBH can benefit from the use of
a multidisciplinary case conference system to address the service needs of clients often treated by MH and SUD
providers.
While SB 326 does not create new funding for substance use disorder services, it will allow MHSA dollars to be
dedicated to substance use services and supports. ACBH also can consider facilitating discussions between agencies
offering mental health and those offering substance use disorder services to help shape how to share MHSA funding
between the two systems.
RECOMMENDATION 7.3
Increase efforts to ensure coordination between and among CBOs for increased transparency
and information sharing to effectively address MH and SUDs.
“Cross-system referrals increased and this was very beneficial. The more that the county pushes cross-
system collaboration and funds it, the better this will work.”
The connection between ACBH and CBOs makes up a network of support. In order for this relationship to develop
further, it requires a more transparent method to share information across systems to ensure the continuum of care for
people with mental health and substance use disorders.
CBOs provide critical support at the local level to provide culturally relevant behavioral health services and are essential
for ACBH to better understand and serve people with co-occurring conditions. ACBH values the impact CBOs have and
can aim to support transparent information sharing with these organizations to reduce access barriers. The department
could work in partnership with trusted CBOs leveraging their valuable insights about community MH and SUD health
needs and foster the development of working relationships with local, county, and state government officials.
Alameda County Behavioral Health (ACBH) Strategic Plan 45
ACBH can create a coordinated effort to meet with CBOs on a quarterly basis to ensure an understanding and
willingness to discuss best practices. ACBH would need to access and recognize the capacity of the CBOs to ensure that
these efforts are not overwhelming.
“Collaborating differently should be a major change that is needed. We leverage our resources to meet
that need.”
RECOMMENDATION 7.4
Evaluate programs for effectiveness and redirect funds to programs that demonstrate higher
levels of quality and outcomes that are meaningful to clients.
People in need of behavioral healthcare deserve access to services that best suit their needs. To improve the quality of
programs, ACBH could plan to create a diverse group that includes ACBH evaluators, clients, and community members
to work together to identify effective metrics that are meaningful to the community and across all programs. Those
metrics will be used to review existing programs and long-standing contracts as Requests for Proposals (RFPs) are issued
and considered for new or renewed funding. This could include the consideration of more funding for peer-managed
or SUD programs and to provide needed resources to effectively meet their mission. Interest should be in funding for
quality of services and not just access to programs.
“Creativity has been a challenge. We want to create novel programs. We spend too much time and
money funding programs that are probably not where we should go.”
Alameda County Behavioral Health (ACBH) Strategic Plan46
AppendicesVII.
APPENDIX A
Literature Review Documents
STRATEGIC PLANNING RESOURCES
> Brief info on Mission Vision Values from ACBH,
and also from ACHCSA
> ACBH Value Based Pilots |
THE PILOT INFO: Tay Older Adult and Youth Summary
> MHSA 3 year plan
> Vision 2026
> Innovation Plans
> Cultural Competence Plan 2019
> Consent Decree
> Disparities Data (raw and summarized)
> Listening Session Summaries
> 1/5/22 Leadership Meeting Summary
Alameda County Behavioral Health (ACBH) Strategic Plan 47
APPENDIX B
Sample Documents for Data Collection
CIBHS LISTENING SESSION TOOLS
ALAMEDA COUNTY BEHAVIORAL HEALTH (ACBH) LISTENING SESSIONS
Introduction to the Planning Project
Thank you for taking the time to meet with me. All of you have been asked to provide your insights and opinions
as we create a Strategic Plan for ACBH. A few key goals of ACBH in creating this plan are to eliminate behavioral
health inequities in access to and quality of behavioral health services; increase their collaboration with the diverse
communities of Alameda County; engage other systems to help address the social determinants of behavioral health
which are exacerbated by racism, such as inadequate housing, employment, education, and elevated risk for justice
involvement; and identify where there are critical gaps in programs and services. We wish to create a plan to inform
funding and policies to address those gaps.
We understand that mental health is influenced by many factors, such as housing and employment, which may extend
beyond ACBH’s scope and influence. However, to ensure we can act on the feedback provided in this listening session,
the following are areas where ACBH can have influence.
> Type of services offered; changes to core clinical services
> Type of provider organizations offering services
> Geographic locations of provider organizations
> Racial and other cultural diversity of staff hired
> Time to access service
> Access points (where and how individuals can access services)
> Honest and meaningful engagement with the community
> Reduction of implicit and explicit bias among providers
> Identification and reduction of structural barriers to access services
> Quality of services
> Training and education offered to county and provider staff
> Partnerships with other systems such as education, housing, public health, and law enforcement
> Outcomes measured
Our hope is that, with your participation today, ACBH will gain insights into how best to prioritize and improve upon its
efforts in these areas. Do you have any questions before we begin our session?
Alameda County Behavioral Health (ACBH) Strategic Plan48
Interview Questions
1. In this current period, what do you think ACBH should prioritize to meet the behavioral health needs of its
diverse communities?
2. To what extent is this happening?
3. What do you think needs to change for the communities’ needs to be better served?
4. What models have you seen, or ideas do you have that would address barriers and build greater systemic
equity and justice?
5. Where would you like to see ACBH build partnerships, and how would these partnerships be beneficial?
6. To what extent are you aware of ACBH’s current policies, practices, and programs? Where can they improve?
7. How do you think you could help to uplift equity within Alameda’s behavioral health system?
Alameda County Behavioral Health (ACBH) Strategic Plan 49
ACBH Demographic Questions
We would like to understand the identities of the people participating in this focus group. All responses will be
confidential and will not be linked to your name in any way in our reporting. However, for taking the time to complete
this survey, we would like to thank you by entering you into a drawing for an additional gift card, so you will have the
option to enter your contact information at the end of the survey.
How do you identify your gender?
Woman Man
Non-binary/third gender Two Spirit
Different identity than these options
Prefer not to state
Feel free to self-describe your gender identity if it was
not provided in the response options above.
What is your racial or ethnic identity?
(check as many options as apply).
Black Latinx/Hispanic
Indigenous/Nat. Asian Am./Pac. Islander
White Different identity than these options
Prefer not to state
Feel free to self-describe your racial or ethnic identity
if it was not provided in the response options above.
How do you identify your sexual orientation?
Bisexual Gay or lesbian
Heterosexual or straight
Prefer not to state
Different identity than these options
Feel free to self-describe your sexual orientation if it was
not provided in the response options above.
Have you personally been involved with the criminal
justice system?
Yes No Prefer not to state
Do you have a substance use or addiction problem?
Yes No Prefer not to state
Have you been diagnosed with a substance use or
addictive disorder?
Yes No Prefer not to state
Have you been treated for a substance use or addictive
disorder?
Yes No Prefer not to state
Have you experienced a mental health condition?
Yes No Prefer not to state
Have you received a mental health diagnosis?
Yes No Prefer not to state
Have you received mental health treatment?
Yes No Prefer not to state
Have you experienced homelessness?
Yes No Prefer not to state
To be entered into the drawing for the additional gift card, please provide us with your contact information: name,
email, and phone number:
Alameda County Behavioral Health (ACBH) Strategic Plan50
CIBHS FOCUS GROUP TOOL
Introduction to the Planning Project for Focus Group Members
Thank you for taking the time to meet with us. We have asked you to be a part of this confidential focus group because
we would like your insights and opinions as we create a 3-year Strategic Plan for Alameda County Behavioral Health, or
ACBH. A Strategic Plan with the input of people who are familiar with its services – both positive and negative – will help
ACBH with its intentions of better meeting the diverse needs of the entire community, improving its communication and
collaboration, closing the gaps in services, making services more accessible, eliminating inequities, getting in front of
problems, and engaging with the other systems that impact people’s lives.
We understand that mental health is influenced by many factors, such as housing and employment, where ACBH may
not have direct influence. To ensure we can act on the feedback provided in this Focus Group, below are areas where
they may have influence.
> Type of services offered; changes to core clinical services
> Type of provider organization offering services
> Geographic location of provider organizations
> Racial and cultural diversity of staff hired
> Time to access service
> Access points (where and how individuals can access services)
> Honest and meaningful engagement with the community
> Reduction of implicit and explicit bias among providers
> Identification and reduction of structural barriers to access and quality of services
> Quality of services
> Training and education offered to county and provider staff
> Partnerships with other systems such as education, housing, public health, and law enforcement
> Outcomes it measures
Our hope is that, with your participation today, ACBH will gain insights into how best to prioritize and improve upon its
efforts in these areas.
Alameda County Behavioral Health (ACBH) Strategic Plan 51
Focus Group Questions
1. How easy is it to access mental health and/or substance use services in ACBH?
2. Do you and your family or community members trust the county enough to want to access its services? What
would help ACBH to build trust with you?
3. Aside from trust, when you feel depressed, anxious, or are experiencing other symptoms of mental health
problems, is there anything else that gets in the way of you seeking help from ACBH?
4. What about substance use issues? If you were concerned about how much you were drinking or using drugs
and its impact on you, your family, or other aspects of your life, would you seek help from ACBH? If yes, what
type of help would you be seeking? If not, what besides trust would get in the way of you getting help from
ACBH?
5. Have you ever entered programs or gotten services from ACBH (outreach, prevention and early intervention,
evaluation and assessment, brief therapy and counseling, day rehab, peer and/or family member support, crisis
services, inpatient hospitalization, case management, or medication evaluation and support)? To what extent
do you feel like these services have helped you and how? What would need to change in your life for you to
believe that ACBH had helped your mental health condition or substance use/addictive disorder?
6. Based on what you know about ACBH, which ones are of such good quality that you would refer a friend or
family member to them?
7. If you do not believe the services have helped you or others in your community, what has gotten in the way?
What changes would you recommend for ACBH to provide better service, including changes to support your
community specifically?
When you think about other agencies (employment, social services, foster care, jail/prison/probation, etc.) you have
been involved with, which ones would serve you better if ACBH was involved? How would you specifically want them to
be involved?
Alameda County Behavioral Health (ACBH) Strategic Plan52
ALAMEDA COUNTY BEHAVIORAL HEALTH (ACBH)
KEY INFLUENCER INTERVIEW TOOL
Introduction to the Planning Project for Key Influencers
Thank you for taking the time to meet with us. We have asked you to be a part of this key informant interview because
we would like your insights and opinions as we create a Strategic Plan for ACBH. A few key goals of ACBH in creating
this plan are to eliminate behavioral health inequities in access to and quality of behavioral health services; increase
their collaboration with the diverse communities of Alameda County; engage other systems to help address the
social determinants of behavioral health which are exacerbated by racism, such as inadequate housing, employment,
education, and elevated risk for justice involvement; and identify where there are critical gaps in programs and services
create a plan to inform funding and policies to address those gaps.
We understand that mental health is influenced by many factors, such as housing and employment, which may extend
beyond ACBH’s scope and influence. However, to ensure we can act on the feedback provided in this key informant
interview, the following are areas where ACBH can have influence.
> Type of services offered; changes to core clinical services
> Type of provider organization offering services
> Geographic location of provider organizations
> Racial and cultural diversity of staff hired
> Time to access service
> Access points (where and how individuals can access services)
> Honest and meaningful engagement with the community
> Reduction of implicit and explicit bias among providers
> Identification and reduction of structural barriers to access and quality of services
> Quality of services
> Training and education offered to county and provider staff
> Partnerships with other systems such as education, housing, public health, and law enforcement
> Outcomes it measures
Our hope is that, with your participation today, ACBH will gain insights into how best to prioritize and improve upon its
efforts in these areas. Do you have any questions before we begin our interview?
Alameda County Behavioral Health (ACBH) Strategic Plan 53
Interview Questions
1. In this current period, what do you think ACBH should prioritize to meet the behavioral health needs of its
diverse communities?
2. To what extent is this happening?
3. What do you think needs to change for the communities’ needs to be better served?
4. Within the communities that you serve, what prevents them from experiencing positive mental health and
well-being?
5. How would you like to see those barriers addressed by ACBH? What ideas do you have or that you’ve heard of
from other communities?
6. How do ACBH’s current policies, practices, and programs benefit its diverse communities? Where can they
improve?
7. Where would you like to see ACBH build partnerships, and how would these partnerships be beneficial?
8. What are your ideas for building greater systematic equity and justice throughout the behavioral health
system?
9. What are the values that you think the county should aspire to when it comes to behavioral health?
10. How do you think your organization/department/agency/office can help to uplift these values?
11. Is there anything else that you think ACBH should consider during its strategic planning process to further its
vision, values, and priorities?
Contact Information:
www.acbhcs.org