California Behavioral Health Transformation: County Performance Accelerator

In 2024, California voters passed Proposition 1, replacing the Mental Health Services Act with the Behavioral Health Services Act (BHSA). BHSA focuses funding on programs that help people with complex challenges, such as serious mental illness, chronic homelessness, and severe or co-occurring substance use disorders. It also adds accountability for results, not just spending.  

From May 2025 to October 2026, Social Finance, the Healthy Brains Global Initiative (HBGI) and the Steinberg Institute ran the County Performance Accelerator on behalf of the California Department of Health Care Services (DHCS). The program gave counties free tools and technical assistance to design a behavioral health system to track and improve outcomes. 

Goals 

• Help counties define and track the outcomes BHSA asks them to report on 
• Show counties how to use provider contracts to set clear expectations and reward results 
• Help Boards of Supervisors and Behavioral Health Boards understand their roles under BHSA and use performance data in their decisions 
• Build these practices into the systems and staff counties already use 

The Work 

• Worked with four counties (Butte, Colusa, San Francisco and Santa Barbara) to assess their contracting practices, data systems and board engagement, then co-developed the toolkit contents 
• Built the Performance Accelerator Knowledge Center, a free online toolkit for all of California’s county behavioral health departments, in four modules: 
  • Building a Performance-Focused Approach: theory of change templates, system and client engagement maps, and a list of key performance indicators for BHSA-required programs 
  • Operationalizing Performance Management: dashboard templates, a performance management charter, and a calendar of review meetings with sample agendas 
  • Contracting as a Tool for Performance: an outcomes-based contracting readiness checklist and workplan, a guide to funding outcomes-based payments, and a scope of work template for new BHSA programs 
  • Facilitating Governance and Accountability: separate review guides for Boards of Supervisors and Behavioral Health Boards, and three-year board engagement calendars 
• Held six webinars, seven workshops, and two regional convenings. Gave personalized technical assistance to 18 counties across more than 30 meetings, and held introductory sessions with 23 counties. Launched the Accelerator Navigator, a chat assistant that helps county staff find the right resources 
• Delivered a final report to DHCS with recommendations across systems measurement, staff and resource capacity, integration across departments, and governance