Promoting Learning Communities to Support Integration, Innovation, and Impact

1. Session F5a Saturday, October 18, 2014 Promoting Learning Communities to Support Integration, Innovation, and Impact Becky Hayes Boober, Ph.D., Senior Program Officer, Maine Health Access Foundation Alejandra Posada, M.Ed., Director of Education and Training, Mental Health America of Greater Houston Rick Ybarra, M.A., Program Officer, Hogg Foundation for Mental Health Collaborative Family Healthcare Association 16th Annual Conference October 16-18, 2014 Washington, DC U.S.A.

2. Faculty Disclosure I/We have not had any relevant financial relationships during the past 12 months.

3. Learning ObjectivesAt the conclusion of this session, the participant will be able to: • Describe at least three examples of learning community structures that lend themselves to varying contexts. • Define at least three challenges and strategies to address such challenges. • Identify at least three opportunities to advance learning communities. • List three resources to help organizations design and implement learning communities.

4. Bibliography / Reference • Brown Levey, S.M., Miller, B.F. & deGruy III, F.V. (2012). Behavioral health integration: an essential element of population-based healthcare redesign. Translational Behavioral Medicine. Published online Jul 26, 2012. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717906/. • Grantmakers for Effective Organizations and Research Center for Leadership in Action (NYU Wagner). (2012). Learn and Let Learn: Supporting Learning Communities for Innovation and Impact. Available at http://www.geofunders.org/resource-library/all/record/a066000000AhjF4AAJ. • Grantmakersin Health & Hogg Foundation for Mental Health. (2013). A Window of Opportunity: Philanthropy’s Role in Eliminating Health Disparities through Integrated Health Care. Available at www.gih.org/files/FileDownloads/Eliminating_Health_Disparities_through_Integrated_Health_Care_August_2013.pdf. • Linkins, K.W., Frost, L., Boober, B.H. & Brya, J. (2013). Moving from partnership to collective accountability and sustainable change: Applying a systems-change model to foundations’ evolving roles. Foundation Review, 5:2, 52-66. • Simon, L.P., Slichta, A. & Monroe, A.F. (2014). Improving Care and Service Coordination for Vulnerable Populations Through Collaboratives: One Funder’s Approach, Impact, and Implications for the Field. The Foundation Review. 6:2, 10-26.

5. Learning Assessment • A learning assessment is required for CE credit. • A discussion and question and answer period will be conducted at the end of this presentation.

6. Maine and Texas IHC Learning Communities – Key Messages and Lessons Learned • Engagement and inclusivity • Creating opportunities for participants to learn from each other and for relationship-building • Access to technical assistance, experts, consultation • Ongoing support and communication • Evaluation emphasis leading to strategic learning and capacity building

7. The Maine Experience

8. History of IHC in Maine • 2006-2013: 42 Clinical Practice and Systems Transformation Grant Awards • 2010-2012: 5 Integrated Care Learning Academy Grant Awards • 2012-2014: 2 Foundation-initiated Integrated Care Systems Grant Awards • 2008-2014: Learning Community Activities • 2014-2018+: DHHS assumes IC learning community leadership through contracts

9. Maine IHC Learning Community • Quarterly Learning Community meetings • Based on grantees’ developmental level in integration • Included inter/national keynote speakers to stretch their thinking • Opportunities to learn from each other (workshops, work sessions) • Topics for Leadership and for Clinical Levels • Days’ Evaluations, Progress Reports, Cross-site Evaluation informed topics • Networking Time (Never Enough!!) • They continued to attend after funding ended

10. Maine IHC Learning Community • Reimbursement Training • Reimbursement Coaching Contract • Integrated Care Training Academy • Evaluation as Tool • Site Self Assessment (Cross-site Training, Discussion) • Taking Learning to the Next Level of Influence: Integrated Care Policy Committee

11. What Worked • Hearing from the Experts (Stretching Them) • Opportunities at Meetings to Learn from Each Other • Relationship-building Activities • Support of Efforts for Engagement between Meetings (Peer-to-peer Learning) • Inclusion of Non-grantees • Collective Policy Impact

12. What Didn’t Work as Well • Web Portal Engagement

13. The Texas Experience

14. Multi-year, multi-site grant program begun in 2006 implementing collaborative care model Statewide conference in 2008; Resource guide published Multi-year learning community begun in 2009 Office of Minority Health / Hogg collaboration (2012). Lit review, consensus report on eliminating health disparities through IHC, and funders report published 2012-2015 planning and implementation grants History of Integrated Health Care in TX

15. Texas IHC Learning Communities • Statewide learning communities funded by the Hogg Foundation for Mental Health and facilitated by Mental Health America of Greater Houston • Two learning communities • 2009 – 2011: Open invitation to sites across the state to participate (17 “teams,” some consisting of two partner organizations) • 2012 – present: Primarily for the Hogg Foundation’s integrated care grantees and partner organizations (10 grantees plus partners) • Diverse participants • Wide range of organizations including FQHCs, community mental health centers, and private non-profits • At different stages in the process (planning, implementation, state leaders) and taking different approaches

16. Engagement and Inclusivity • Challenge of balancing inclusivity with optimal level of engagement • Participant activation – “What’s in it for me?”

17. Shared Learning & Relationship-Building • Challenge of geography in a BIG state • Diverse opportunities to connect both long-distance and in-person – Monthly conference calls, webinars, web portal, listserv (Google group), site visits, annual grantee meetings • Funding for travel to site visits and grantee meetings

18. Access to Expertise • For the coordinator (MHA Greater Houston): • First learning community – Ongoing consultation from both state and national experts (National Council) • Second learning community – MHA built internal knowledge/capacity during the first LC; same level of consultation no longer necessary • For the participating organizations: • Funding for consultation available through MHA’s grant • Flexibility in terms of both content and format • Making it “easy” for organizations to access consultation

19. Ongoing Support & Communication • “Three Bears” version of communication – Not too much, not too little, just right… • Weekly e-mails – Information about learning community activities but also other resources and learning opportunities (e.g., CFHA webinars, CIHS resources) compiled in an easy-to-access format • Create sense (and actuality!) of “being supported” – Regular communication, availability, openness

20. Evaluation Emphasis • Promote a “culture of evaluation” (For a brief, practical piece on this topic, see http://www.fieldstonealliance.org/client/tools_you_can_use/06-20-07_evaluation_culture.cfm) • Weave into the various LC activities • Emphasize evaluation as a process to continually improve programming as opposed to “something I have to report or I’ll lose my funding” • Recognize the value of challenges/things that don’t go as planned – Opportunities for learning • “Consultation model” of evaluation to help build internal evaluation capacity • Strategic learning for participants, facilitator, and foundation • Evaluation executive summary from first learning community - http://www.hogg.utexas.edu/uploads/documents/TLC%20Summary%20Report_final1.pdf

21. Challenge of Sustainability • Programmatic • Flexibility – Needs to evolve to meet changing needs • Participant “burn out” – Keeping it fresh and relevant • Financial • As LC evolves, funding may also need to evolve – New funders interested in evolution of LC? Fee to participate? • What can be done without a great deal of funding? What are the “low hanging fruit”?

22. Final Thoughts • One size does not fit all • No single “right” or “wrong” way • Certain key elements are essential ingredients • Start with the essentials and tailor to the specific circumstances • A final challenge – THINK COLLECTIVE IMPACT!

23. Discussion & Questions Some guiding questions for discussion: • Have you engaged in learning communities/ shared learning endeavors? Do the themes we discussed resonate with your experience? Are there other “key messages” or “lessons learned” that are particularly salient in your experience? • What could you do to advance shared learning in your community? First steps towards a learning community? Next steps for an already existing learning community? • What opportunities for collective impact do you see in learning communities?

24. Contact Information

25. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!