Developing a Behavioral Health Capacity Assessment Tool for a Large, Urban Area: Chicago's Story

BACKGROUND:  Improving access to and availability of behavioral healthcare services for Chicago residents is a priority for the Chicago Department of Public Health (CDPH) as identified through Chicago’s Community Health Improvement Plan, Healthy Chicago 2.0. While CDPH published a mental health profile of existing Chicago services in 2006, the landscape of behavioral healthcare options is constantly evolving, and has been doing so more rapidly with changes introduced by the Affordable Care Act. One Healthy Chicago 2.0 strategy is to better understand behavioral healthcare service access by conducting an assessment of the strengths, weaknesses, capacity, and gaps of the behavioral health system.  To address this, a behavioral health capacity assessment was initiated in September 2015 and included three domains: mental health, substance abuse, and violence. The focus will be on the first three phases of the assessment: (1) conceptualization, (2) data collection tool development, and (3) identification of behavioral healthcare agencies, all critical to the project’s success.

METHODS:  During the conceptualization phase, meetings were held with behavioral health stakeholders, specifically local and national content experts. Information gleaned resulted in two data collection tools: an online survey, and three focus group guides. Agencies were identified from multiple existing comprehensive lists and each agency was contacted several times, by telephone or email.

RESULTS:  During phase one, stakeholders provided guidance on important aspects of capacity to investigate, shaping both the focus and content of the assessment, and existing surveys created by the Substance Abuse and Mental Health Service Administration (SAMHSA) provided validated questions. Stakeholders reviewed the survey and focus group guides in phase two, and provided feedback about accessibility of information, question wording and content, and survey length.  In phase three, stakeholders assisted with identifying possible participant agencies by facilitating introductions to large associations as well as providing referral lists. The final participant list consisted of over 250 behavioral health agencies in Chicago, IL. Collaboration and communication between CDPH programs involved was crucial throughout the process. 

CONCLUSIONS:  Involvement of numerous and diverse stakeholders greatly enhanced the quality of the assessment tools and potential participant agencies, though engagement added time to the process. Stakeholder input ensured that the information collected was relevant and useful to the community, the assessment had an adequate scope and reach, and data collection tools were understandable and appropriate. This is a process that can be used in other public health jurisdictions to evaluate current services, and develop plans for improvement.