The Challenge
Too often, children with developmental concerns face long wait times and other barriers to actually receiving the services they need. This is a problem since the earlier interventions are received, the more effective they can be.
In Los Angeles County, early identification and intervention services and supports are provided by various agencies and community-based organizations across seven different catchment areas. These agencies and referral partners have sometimes been fragmented and operated in silos, with unclear referral processes and pathways, contributing to families having difficulty navigating and accessing developmental services. First 5 LA saw these disjointed networks as a critical barrier to children receiving needed services, and wanted to change it.
How can a funder effectively support multiple diverse community partners - and their networks of partners - to develop effective referral processes?
The Approach
First 5 LA, in partnership with the Los Angeles County Department of Public Health, sought a technical assistance and evaluation lead for its Help Me Grow LA initiative, which focuses on improving the early intervention system. Their goal was to help seven community collaboratives strengthen and expand referral pathways so that all children at risk of delays would be connected to critical services as early as possible through closed loop referrals.
VIVA was selected as the technical assistance provider and evaluator, helping develop and implement the three-year Help Me Grow Pathways pilot initiative, providing technical assistance and capacity building, data collection, analysis, and evaluation.
Why Pathways?
California established new requirements for Medi-Cal health plans to improve their care management and better help patients navigate the healthcare system and the referrals they’re given. “Closed loop referrals” mean that when patients are referred for a specialized service, the referer or another partner is making sure that the patient actually receives that service.
The steps in that process are called the “referral pathway.” In other words, someone is helping the patient all the way along the path until the loop is closed and the patient has received the service.
Because First 5 LA was working with multiple lead partners and all of their referral networks, there was no single solution. The pathways for each, and work they needed to do to strengthen them, would necessarily be different. Our goal was to build each of their capacity for strong pathways through individual and collective technical assistance and support.
Technical Assistance
VIVA worked with the seven partners to develop and implement both a technical assistance and training plan and an evaluation plan for each of their pilot efforts.
Each selected a set of strategies that they would focus on testing, and then VIVA worked with them to develop a tailored technical assistance and training plan to support their implementation. The technical assistance approaches that were employed primarily focused on: 1) leveraging and embedding technology into referral workflows to improve access and system connectivity, and 2) strengthening partnerships, community engagement, and capacity in these LA County communities.
The technical assistance VIVA provided spans disciplines, but includes a focus on helping these partners better understand and meet the needs of the families who are in need of early identification and intervention services. One example of this was Family Journey Mapping, which is a tool for helping to understand families’ experiences navigating systems.
With Family Journey Maps, we can center the experiences of families and consider changes that are directly motivated by user experience. VIVA created a process and tools to equip our partners to engage families and conduct their own family journey mapping processes in order to identify barriers and guide their Help Me Grow Pathways work. VIVA then provided additional technical assistance and graphic design support, to create visually appealing maps that can serve as tools for these partners over the course of their work.
Evaluation
There were two cohorts of community collaboratives. The first cohort, made of five agencies and their partners, began their referral pathways activities in October 2020 and completed them in December 2023. The second cohort, made of two agencies and their partners, began their activities in July 2022 and will complete them in June 2025.
VIVA employed a continuous quality improvement framework, Plan-Do-Study-Act, to develop tailored Data Collection, Evaluation, and Learning Plans for each agency, that would support an evaluation of the HMG LA Pathways program.
VIVA also developed the following tools to support data collection and the evaluation process:
- Data Dashboards: Interactive tools summarizing outcome findings with demographic filters.
- Data Briefs: Customized summaries, highlighting findings and discussion points.
- Referral Heatmaps: Visual maps showing referrals by location, overlaid with socioeconomic data.
- Parent/Caregiver Surveys: Tools to capture feedback on referral satisfaction and accessibility of services.
- Collaborative Partner Surveys: Instruments to assess partner engagement and system usability.
- Administrative Data Collection Templates: Tools for collecting standardized information on referral outcomes and timelines.
- Learning Session Notes: Insights from biannual cross-agency sessions to address common challenges and share best practices.
- Technical Assistance Support Materials: Resources to guide agencies in data collection, platform implementation, and collaborative evaluation.
This structured and participatory evaluation approach enabled continuous improvement while strengthening partnerships and enhancing the capacity of participating agencies.
The Impact
The results from these pilot efforts were very successful and increased a tremendous amount of learning amongst stakeholders. Importantly, partner collaboration, coordination, and communication for referrals improved throughout the project. There were measurable increases in the number of partners who use online referral systems and tracked referrals.