Partnerships with Local Health Services: Bridging Clinical Care and Community Support
Health outcomes depend on far more than clinical care. Social determinants—housing, food security, social connection, safety—profoundly affect health. Community organizations often address these determinants but lack clinical capacity, while health services have clinical expertise but limited reach into communities. Partnerships between local health services and community organizations can bridge this gap, combining clinical resources with community connections to improve health outcomes. Understanding how these partnerships work helps communities build more effective responses to health needs.
Why Partnerships Matter
Health systems can't address social determinants alone. Hospitals and clinics aren't designed to provide housing, food, or social support—but these factors heavily influence patient outcomes.
Community organizations reach people health systems miss. Many people don't engage with formal healthcare until crisis. Community organizations may have relationships with people who avoid clinical settings.
Trust exists in different places. Some people trust community organizations more than medical institutions, especially communities with histories of medical mistreatment. Partnerships can leverage existing trust.
Resources exist in different sectors. Health systems have clinical resources, funding, and professional expertise. Community organizations have relationships, cultural knowledge, and presence in neighborhoods. Partnerships combine these assets.
Types of Partnerships
Referral relationships connect clients to services. At the simplest level, health providers refer patients to community services and vice versa. These connections help but don't involve deep integration.
Co-location embeds services together. Community health workers or social services located within health facilities, or clinical services within community settings, make access easier for clients.
Care coordination aligns efforts around individuals. Formal coordination mechanisms ensure that clinical and community supports work together for individual clients rather than operating in parallel.
Population health partnerships address community-wide concerns. Health systems and community organizations collaborate on community-wide health improvement strategies beyond individual patient care.
Advocacy partnerships address systemic factors. Joint advocacy for policy changes affecting health—housing policy, environmental conditions, food systems—addresses upstream determinants.
Community Health Workers
Community health workers bridge systems. These frontline workers from communities they serve connect clinical care with community life, providing culturally appropriate support and navigation.
Trust and cultural knowledge are their assets. Community health workers' value lies in relationships and cultural competence that professional credentials don't automatically provide.
Roles span clinical and community domains. Community health workers may provide health education, care navigation, social support, advocacy, and connection to resources—spanning what formal systems separate.
Employment by community organizations maintains connection. When community health workers are employed by community organizations rather than health systems, they may maintain closer community ties and trust.
Addressing Social Determinants
Screening identifies social needs. Health providers increasingly screen for social determinants—housing instability, food insecurity, safety concerns—to identify needs that affect health.
Partnerships enable response to identified needs. Screening without ability to address identified needs is frustrating for all. Partnerships with community organizations provide response capacity.
Closed-loop referrals ensure connection. Systems that track whether referrals result in actual service connection—and follow up when they don't—ensure referrals achieve their purpose.
Addressing social needs improves health outcomes. Research increasingly shows that addressing social determinants through partnerships improves health outcomes and can reduce healthcare costs.
Mental Health and Substance Use
Community-clinical partnerships serve behavioral health. Mental health and substance use treatment benefit particularly from partnerships that combine clinical services with community support.
Peer support connects to treatment. People with lived experience can engage those reluctant to access clinical services and support continued engagement after treatment episodes.
Community settings may be more accessible. For some, community-based services feel more accessible and less stigmatizing than clinical psychiatric facilities.
Recovery requires community as well as treatment. Sustained recovery from mental health challenges or substance use disorder requires community connections that clinical treatment alone doesn't provide.
Challenges of Partnership
Power imbalances affect relationships. Health systems typically have more resources and institutional power than community organizations. Genuine partnership requires addressing these imbalances.
Different organizational cultures create friction. Health systems and community organizations often have different decision-making processes, timelines, communication styles, and values. Cultural differences must be bridged.
Funding flows don't support partnership. Healthcare funding typically flows to clinical services, not community partnerships. Sustainable funding for partnership activities remains challenging.
Data sharing faces barriers. Clinical privacy requirements can impede the information sharing partnerships require. Legal and technical solutions to data sharing challenges are needed.
Staff turnover disrupts relationships. When key staff change, partnership relationships may weaken. Institutional structures that survive staff changes are needed for sustainability.
Building Effective Partnerships
Shared goals align efforts. Partnerships need clear, shared objectives that both parties are committed to achieving. Misaligned goals undermine collaboration.
Governance structures formalize relationships. Memoranda of understanding, joint committees, and formal agreements provide structure that informal relationships lack.
Resource sharing reflects genuine commitment. When health systems share resources with community partners—funding, space, staff time—they demonstrate commitment beyond rhetoric.
Communication maintains alignment. Regular communication through meetings, shared systems, and informal contact keeps partnerships functioning through inevitable challenges.
Evaluation assesses outcomes. Partnerships should evaluate whether they're achieving intended outcomes, enabling adjustment when they're not.
Health System Transformation
Value-based payment creates incentives. As healthcare payment shifts from fee-for-service to value-based models, health systems have financial incentives to improve outcomes through community partnerships.
Population health orientation shifts focus. Health systems increasingly responsible for population health—not just patients who present for care—need community partners to reach whole populations.
Anchor institution strategies connect health systems to communities. Health systems as major employers and purchasers can affect community health through hiring practices, purchasing policies, and community investment beyond clinical services.
Examples of Partnership Models
Federally Qualified Health Centers integrate clinical and community health. These community health centers combining primary care with community outreach demonstrate integration within single organizations.
Hospital-community partnerships address local health priorities. Many hospitals partner with community organizations to address specific local health priorities identified through community health needs assessments.
Accountable health communities coordinate care. Emerging models that make health systems accountable for community health outcomes incentivize robust community partnerships.
Community Organization Perspectives
Partnerships should serve community interests. Community organizations should ensure partnerships serve their missions and communities, not just health system interests.
Fair compensation recognizes contribution. When community organizations contribute to health outcomes, they deserve fair compensation—not exploitation of their community connections for health system benefit.
Maintaining independence preserves mission. Community organizations partnering with large institutions must maintain independence to advocate for community interests, even when those conflict with partner interests.
Conclusion
Partnerships between local health services and community organizations can address the gap between clinical care and social determinants that profoundly affect health. These partnerships combine clinical resources with community connections, professional expertise with cultural knowledge, and institutional capacity with grassroots relationships. Challenges of power imbalance, cultural difference, funding, and data sharing must be addressed for partnerships to succeed. As healthcare increasingly recognizes that health happens in communities—not just clinics—partnerships with community organizations become not just beneficial but essential for achieving health outcomes that clinical care alone cannot deliver.