Coordinating Community Care in Los Angeles County

Findings from interviews with safety net providers across Los Angeles County, gathered between June and September 2026.

A regional report prepared by California Coverage and Health Initiatives (CCHI), funded in part by the California Wellness Foundation

READ THE REPORT

Who We Heard From

1736 Family Crisis Center ↗ Alliance for a Better Community ↗ Alzheimer's Los Angeles ↗ Antelope Valley Partners for Health ↗ Asian Americans Advancing Justice Southern California ↗ AWOKE ↗ Beach Cities Health District ↗ California Community Foundation ↗ California Domestic Workers Coalition ↗ California Immigrant Policy Center ↗ California Work & Family Coalition ↗ Children's Hospital Los Angeles ↗ CLEAN Carwash Worker Center ↗ Coalition for Responsible Community Development ↗ Community Clinic Association of Los Angeles County ↗ Confluence Rising ↗ Disability Community Resource Center ↗ Easterseals Southern California ↗ Give For a Smile ↗ Hathaway-Sycamores Child and Family Services ↗ Hollywood Food Coalition ↗ Integrated Recovery Network ↗ Koreatown Youth and Community Center ↗ L.A. Care Health Plan ↗ Long Beach Community Action Partnership ↗ Los Angeles Coalition for Aging (LACA) ↗ Los Angeles County Department of Homeless Services and Housing ↗ Los Angeles County Office of Immigrant Affairs ↗ Maternal Mental Health NOW ↗ National Health Care for the Homeless Council ↗ ONEgeneration ↗ Pacific Asian Counseling Services ↗ Pacific Clinics ↗ Project Angel Food ↗ Public Counsel ↗ Service Center for Independent Life (SCIL) ↗ SHARE! Self-Help And Recovery Exchange ↗ South Asian Network ↗ South Bay Cities Council of Governments ↗ St. Barnabas Senior Services ↗ St. Vincent Meals on Wheels and Hotel Dieu ↗ Strategic Actions for a Just Economy (SAJE) ↗ Telecare Corporation ↗ The Los Angeles Trust for Children's Health ↗ The TransLatin@ Coalition ↗ Trans Can Work ↗ USC Equity Research Institute ↗ WISE & Healthy Aging ↗ Young & Healthy ↗ Young Adult Institute, Inc. (YAI) ↗

Regional

Priorities

Engage community meaningfully.

Advance innovative funding for increased capacity and collaboration.

Coordinate shared referral infrastructure and uplift accessible technology.

Invest in workforce sustainability.

Improve complex processes.

California Health Interconnectivity Initiative · Los Angeles County

Bright spots: where coordination is already working

Across Los Angeles County, safety net providers are connecting sectors, sharing resources and expertise, strengthening community voice, and building more coordinated pathways to services. Filter by category, or click any model to read more.

38 models

Cross-sector partnerships and shared tables

Awoke Foundation Unite afterschool programming with LAUSD

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Through its Unite program, Awoke Foundation partners with LAUSD to bring dance, music, art, and DJing directly into schools. Relying on both professional instructors and existing school staff, the model brings enrichment to students where they already are, rather than requiring families to get kids to an outside center.
Cross-sector partnerships and shared tables

California Community Foundation pooled philanthropy and co-investment

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California Community Foundation has used pooled funding and co-investment models to bring multiple philanthropic partners together around shared regional priorities. Funders can combine resources, reduce duplication, and make larger coordinated investments in Los Angeles communities rather than supporting disconnected projects.
Cross-sector partnerships and shared tables

CCALAC Annual Workforce Summit

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The Community Clinic Association of Los Angeles County hosts an annual Workforce Summit where community health centers work through shared challenges in recruitment, retention, leadership, and organizational culture. Bringing organizations facing similar pressures together supports peer learning and regional problem-solving.
Cross-sector partnerships and shared tables

South LA All In

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Coalition for Responsible Community Development convenes South LA All In, a coalition of smaller and grassroots nonprofits building regional capacity in South Los Angeles. A larger neighborhood-based organization provides convening infrastructure, relationships, and administrative capacity, creating space for smaller organizations to connect, share resources, and pursue opportunities they may not be able to access on their own.
Cross-sector partnerships and shared tables

Confluence Rising Roots of Justice Convening

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Confluence Rising's annual Roots of Justice conference invites partner organizations to lead workshops, giving them a platform and a new audience while expanding what the host can offer without building all that expertise in-house. Multi-year unrestricted funding has made it possible to plan further ahead, including a newer collaborative grant supporting co-designed work.
Cross-sector partnerships and shared tables

Los Angeles County Emergency Rent Relief Program

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Administered by the Department of Consumer and Business Affairs, the program provides financial assistance to eligible tenants, landlords, and in some cases displaced homeowners facing unpaid rent, mortgage debt, or other housing costs after an emergency or financial hardship. Eligible applicants may receive up to six months of assistance, generally capped at $15,000 per rental unit, helping families stay housed and connected to school, work, and care.
Cross-sector partnerships and shared tables

Hathaway-Sycamores Residential Based Services collaborative pilot

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Hathaway-Sycamores took part in a Residential Based Services pilot that brought DMH, DCFS, and CBOs to the same table. A dedicated consultant ensured collaboration and shared risk and reward across partners, with the ability to co-create contract terms directly with the county. The model offers an alternative to standard competitive bidding, letting organizations build shared solutions instead of competing for the same funding.
Cross-sector partnerships and shared tables

LBCAP Aging Services Collaborative

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Long Beach Community Action Partnership's Aging Services Collaborative brings together agencies serving older adults for quarterly meetings to share advocacy updates and opportunities. When city funding for the collaborative lapsed, LBCAP secured funding to keep it going.
Cross-sector partnerships and shared tables

South Bay Cities Council of Governments regional fiber network

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After finding that member cities were paying high costs for limited internet service, the South Bay Cities Council of Governments built its own self-funded regional fiber network, redirecting transportation funding toward an unaddressed regional need. The model shows how a council of governments can take on a shared infrastructure problem that individual cities would struggle to solve alone.
Cross-sector partnerships and shared tables

Multi-Partner Disaster Preparedness Collaborative

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A disaster preparedness grant distributed resources across partner organizations including St. Barnabas Senior Services, the Family Caregiver Coalition, Salvation Army, Bet Tzedek, ONEgeneration, and YMCA. Each partner brought different expertise and communities to the work, expanding reach while letting organizations focused on older adults, caregivers, families, legal services, and disaster response build on their existing strengths.
Cross-sector partnerships and shared tables

RepresentLA

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RepresentLA grew out of the L.A. Justice Fund, a two-year pilot funded by the County and City of Los Angeles, the California Community Foundation, and the Weingart Foundation to provide free legal representation to immigrants facing removal proceedings. After the pilot demonstrated need and effectiveness, the County and City established RepresentLA as an ongoing public program. Administered by the County Office of Immigrant Affairs, it currently funds 15 nonprofit immigration legal service providers.
Navigation, data, and integrated care

AAAJ Southern California Garvey School District Medical-Legal Partnership

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Asian Americans Advancing Justice Southern California brings legal assistance into schools in the Garvey School District in the San Gabriel Valley. Placing support inside a familiar, trusted setting creates a community-based access point for families who may otherwise struggle to reach legal services, and connects legal help with the broader needs of children and families.
Navigation, data, and integrated care

Alzheimer's Los Angeles AlzDirectConnect warm handoff referral tool

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Alzheimer's Los Angeles built a direct referral tool that connects families facing dementia-related needs to services so they don't get lost between agencies. The tool reflects the organization's broader advocacy for dementia-capable systems, where families feel the benefit of coordination rather than navigating it alone.
Navigation, data, and integrated care

allcove Beach Cities

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Beach Cities Health District's allcove Beach Cities brings mental health, physical health, substance use prevention, peer support, family support, and education and employment assistance together in one youth-centered setting. Serving young people ages 12 to 25 in the South Bay, it lets youth reach multiple forms of support through one welcoming entry point.
Navigation, data, and integrated care

Children's Hospital Los Angeles Child Health and Wellness Collaborative

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Children's Hospital Los Angeles brings clinical and community-based partners together around social drivers of health, addressing economic hardship, food insecurity, housing instability, and healthcare access as connected issues rather than separate referrals. Formerly the hospital's Community Benefit Council, the Collaborative focuses on improving outcomes for children, youth, and young adults.
Navigation, data, and integrated care

Expand LA shared afterschool coordination and intake platform

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Expand LA invested in a shared technology platform for intake and coordination across afterschool programming, a concrete step toward reducing fragmentation in a sector where coordination often stalls after an initial burst of enthusiasm. The effort has gained renewed momentum following recent fires and emergencies, with a growing focus on environmental and community health.
Navigation, data, and integrated care

LA County Department of Homeless Services and Housing InfoHub

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InfoHub brings information from multiple county-funded databases together to identify the services an individual has received across otherwise disconnected systems. The county is pairing this work with a broader data blueprint intended to reduce duplicate entry and improve client visibility and care coordination across the homelessness system.
Navigation, data, and integrated care

LA Trust school-based health data exchange platform

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The Los Angeles Trust for Children's Health runs a data exchange that lets partner organizations see shared information about the same young people across systems. It supports the broader Transforming Together initiative, which connects school, community, and children's health investment.
Navigation, data, and integrated care

Pacific Clinics Health Navigation Intervention Model

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Pacific Clinics' Health Navigation model equips peers, community health workers, and other providers to help people with serious mental illness navigate physical healthcare. The model bridges behavioral and physical health services while gradually shifting navigation skills from the provider to the individual, so people can increasingly manage their own care.
Navigation, data, and integrated care

St. Vincent Meals on Wheels and Cedars-Sinai post-surgical meal partnership

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St. Vincent Meals on Wheels partners with Cedars-Sinai to deliver frozen meals to orthopedic trauma surgery patients recovering at home, with plans to build referral pathways into St. Vincent's other services. The partnership connects a hospital's post-surgical care directly to a community-based nutrition provider rather than leaving recovery nutrition to chance.
Navigation, data, and integrated care

WISE & Healthy Aging 911 Hot Handoff Program

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WISE & Healthy Aging partners with the Santa Monica Fire Department to identify people who call 911 repeatedly because of unmet social needs like isolation, housing instability, or lack of in-home support. Firefighters refer these callers directly to WISE case managers, who follow up on the underlying issue. WISE reports that inappropriate 911 use fell by more than half among enrolled clients, with the drop holding steady six months later.
Navigation, data, and integrated care

YAI START

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START provides crisis prevention and mental health support for people with intellectual and developmental disabilities and co-occurring behavioral health needs. Through YAI and the Frank D. Lanterman Regional Center, the model coordinates crisis planning, response, consultation, therapeutic support, and family and provider assistance around the individual, so families don't have to navigate disconnected systems.
Community-led advocacy

Los Angeles Coalition for Aging intrastate funding formula advocacy

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When a proposed California Department of Aging funding formula threatened to cut Los Angeles County's aging services funding by approximately 17%, the equivalent of roughly 400,000 meals, LACA mobilized its members around a shared response. Coordinated advocacy helped put the formula on hold and require additional community engagement.
Community-led advocacy

Stay Housed LA right to counsel

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Stay Housed LA brings housing justice organizations together behind the county and city's push toward universal right to counsel in eviction cases. The effort builds on the earlier Shriver pilot program, which generated data showing that right-to-counsel representation improves outcomes.
Community-led advocacy

United to House LA

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United to House LA is the coalition behind Measure ULA and its investments in affordable housing and homelessness prevention in the City of Los Angeles. The model connects grassroots organizing, policy advocacy, tenant expertise, and a dedicated public revenue source, creating a pathway from community-defined priorities to sustained public investment.
Community-led advocacy

TransLatin@ Coalition SB 923 cultural competency training

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SB 923, the Inclusive Care Act, requires managed care plans to complete cultural competency training from organizations that are at least 60 percent trans-serving. This positions the TransLatin@ Coalition as a training resource that health plans and hospitals can draw on directly, shifting the burden of education away from community members having to retell personal stories.
Community trust and engagement

CLEAN Carwash Worker Center Public Health Councils Program

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CLEAN partners with Los Angeles County public health efforts to organize and educate car wash workers around workplace health, safety, and labor protections. The model connects public health infrastructure with a trusted worker organization that can reach employees who may otherwise have little direct connection to government systems.
Community trust and engagement

Easterseals Southern California "Disability is Not a Dirty Word"

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This campaign uses disability pride messaging and the voices of people with disabilities to challenge stigma and change how disability is discussed across Southern California. It treats cultural narrative change as part of creating more inclusive services, institutions, and communities.
Community trust and engagement

Vision y Compromiso Immigration Response Coalition

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Formed in response to immigration enforcement concerns, this coalition brings multiple sectors together to protect community members seeking services. It draws on trusted, culturally embedded organizations to reach Latino community members who may otherwise avoid services out of fear.
Community trust and engagement

Maternal Mental Health NOW Los Angeles Maternal Mental Health Access Project

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LAMMHA brings health centers, behavioral health experts, technical assistance organizations, and other partners together to strengthen identification and treatment of perinatal mental health conditions. Rather than creating a separate system, it builds capacity within existing community health settings, helping providers integrate behavioral health into the places where families already receive care.
Community trust and engagement

South Asian Network Faith-Based Leader Toolkit

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South Asian Network equips faith and community leaders with culturally responsive tools to recognize, address, and prevent domestic violence. Because these leaders are often the first people survivors turn to, the approach extends support through relationships that already exist in the community, reaching people who might never contact a formal service organization directly.
Community trust and engagement

Young & Healthy Eaton Fire legal aid and mental health support

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Young & Healthy partnered with a local clergy coalition to pair mental health support with legal aid workshops helping mixed-status families secure custody and guardianship documentation in case a parent is removed from the home. Each organization brought its own strength to a single event meeting a need neither could fully address alone.
Housing, stability, and community-based support

1736 Family Crisis Center #SheDoesHaven interim bridge housing

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One of the City of Los Angeles' A Bridge Home shelters, #SheDoesHaven began as a grassroots effort to support unhoused women in Council District 10. In partnership with CD 10 and the mayor's office, 1736 Family Crisis Center operates the 15-bed site for single women without accompanying children, built from repurposed shipping containers. The model pairs a low-barrier, housing-first approach with case management and supportive services to help residents move into permanent housing.
Housing, stability, and community-based support

Alliance for a Better Community Fuerza Fund fire recovery cash assistance

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AFBC's Fuerza Fund provides direct cash assistance to people affected by the 2025 LA fires and funds Latino-led nonprofits supporting fire-affected students at East LA College and Pasadena City College. Because the assistance is flexible, it reaches people faster than more restrictive aid programs typically allow.
Housing, stability, and community-based support

Antelope Valley Partners for Health AV Food Hub

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Antelope Valley Partners for Health runs a food hub that brings in over 10,000 pounds of fruits and vegetables twice a month, distributed through more than a dozen partners including schools, faith-based groups, and other CBOs. Member organizations handle their own distribution once food arrives, letting a single hub serve a large region efficiently.
Housing, stability, and community-based support

LA Food Collective shared warehouse and food recovery network

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In May 2025, Hollywood Food Coalition helped launch the LA Food Collective with API Forward Movement, Polo's Pantry, and Sunrise Organic Farms. The collective connects farms, food rescue organizations, and community distributors through a shared physical space, expanding each partner's capacity while building infrastructure for community food distribution across Los Angeles. It has drawn interest as a model for replication.
Housing, stability, and community-based support

LA ADU Accelerator Program

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The LA ADU Accelerator Program connected older adults in need of affordable housing with homeowners willing to rent accessory dwelling units, supporting the tenant relationship and navigation process. It used existing housing stock to create additional housing opportunities for older Angelenos. The program has since sunsetted.
Housing, stability, and community-based support

SHARE! Peer-Run Respite

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SHARE! operates peer-run respite services that offer people experiencing mental health challenges short-term support outside a traditional institutional setting. The model combines peer support, recovery planning, and connections to behavioral health and community services, offering an alternative for people who may not need or benefit from an emergency or hospital-based response.