The BHSA Transition Guide Part 7: Understanding DHCS’s Theories of Change for Statewide Behavioral Health Goals
This July, the Department of Health Care Services (DHCS) released Behavioral Health Transformation: Theories of Change for Statewide Behavioral Health Goals—a framework for how county behavioral health (BH) and Medi-Cal managed care plans (MCPs) can advance each of the statewide BH goals under the Behavioral Health Services Act (BHSA). While much of the attention on BHSA reporting has focused on measure specifications and deadlines, the Theories of Change document explains the state’s logic for why certain county strategies are expected to produce certain results.
This post addresses:
- What is a theory of change, and why does DHCS use one?
- How is the framework structured?
- What does this mean for county programming and reporting?
- How can EVALCORP help counties apply the framework?
What Is a Theory of Change, and Why Does DHCS Use One?
A theory of change can be structured as an “if, then” statement: if a specific action is taken, a specific result is expected to follow, based on evidence and experience. It’s similar to a logic model in that it connects what an organization does to what it hopes to achieve, and it’s commonly used in public health and human services to make the reasoning behind a program or intervention explicit.
DHCS built its Behavioral Health Transformation (BHT) Theories of Change around four consistent elements applied across all fourteen statewide behavioral health goals:
Key Elements in a BHT Theory of Change
- Levers: The targeted interventions, investments, and operational requirements used to carry out a strategy.
- Strategies: The approach counties and MCPs take to advance the goal.
- Results: The measurable outcomes that indicate a strategy is working.
- Goal: The statewide outcome DHCS is seeking for Medi-Cal members and people eligible for county behavioral health services.
How is the framework structured?
Under the goal of Reducing Homelessness, DHCS’s first strategy calls on counties to identify and address housing needs for people with behavioral health needs who are experiencing or at risk of homelessness. That strategy breaks down into three specific tactics, each paired with its own set of levers:
- Tactic A—Identify people at risk: Use outreach, referrals, and population health data (including Medi-Cal Connect) to find people at risk of or experiencing homelessness, including those transitioning from institutional or carceral settings.
- Tactic B—Address housing needs directly: Respond to housing needs and immediate safety risks by leveraging resources such as Flexible Housing Subsidy Pools and BHSA Housing Interventions to secure federal vouchers.
- Tactic C—Close housing supply gaps: Collaborate with Continuums of Care, public housing authorities, and county or municipal housing departments to invest in permanent supportive, affordable, and interim housing.
The levers tied to this strategy include BHSA Housing Interventions, Enhanced Care Management, Housing Community Supports (including Transitional Rent), Flexible Housing Subsidy Pools, and BHSA Housing Capital Development Projects. Each one is a specific, fundable mechanism a county can point to.
The expected results include fewer people becoming homeless and less time spent unhoused among those who do. DHCS then measures progress in two ways: one or more goal measures, such as tracking homelessness prevalence among people with significant behavioral health needs, and one or more intervention measures, such as tracking whether housing and Full Service Partnership services were delivered to that population. Each of the fourteen goals follows this structure.
What Does This Mean for County Programming and Reporting?
For counties, the Theories of Change document is meant to work in two directions. Looking forward, it’s a planning tool: counties can compare their current programming against DHCS’s defined strategies and levers to identify where existing services already align and where meaningful gaps remain. Looking backward, it’s a reporting tool: because BHSA performance measures are built directly from this framework, counties need to understand which measure corresponds to which link in the chain in order to report results in a way DHCS can interpret as progress.
DHCS is explicit that many of these goals involve factors outside a county’s direct control, particularly where cross-sector partners like housing authorities or correctional systems are involved. The framework isn’t a guarantee that county action alone will move a statewide number; it’s a definition of the specific piece of the chain each county is responsible for.
How Can EVALCORP Help Counties Apply the Framework?
EVALCORP supports counties in translating the Theories of Change framework into practical programming and reporting decisions. Our services include:
- Program-to-strategy mapping, comparing existing county programming against DHCS-defined strategies and levers to identify alignment and gaps.
- Local logic model development, adapting the statewide framework to a county’s specific population, providers, and partnerships.
- Data structuring support, organizing county data collection to align with goal, sub-goal, and intervention measure categories.
- Reporting narrative development, helping counties present results to DHCS in a way that connects data back to the state’s own theory of change logic. For example, counties are expected to identify programmatic changes or strategies that specifically address measures where the county is underperforming compared to the state rate. Adapting the language from the theories of change into program planning and reporting (e.g., in the Annual Update) can a) help counties identify additional interventions that the state expects the counties to implement, or b) validate that “best practices” are being implemented, and further performance improvements may require innovative or broader system changes beyond the scope of county behavioral health departments.
As DHCS continues to roll out BHSA reporting requirements, understanding the reasoning behind the state’s performance measures is just as important as meeting the deadlines attached to them. EVALCORP is ready to help your county make sense of the Theories of Change framework and put it to work.
Please contact us to learn how we can support your county’s BHSA implementation and reporting.
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