The Charge
Central Iowa Community Services (CICS) engaged Rural Policy Partners to strengthen collaboration among behavioral health and human service providers across its regional service system.
The project initially centered on strategic planning for an access center model, including exploration of whether an existing facility in Webster City could help address gaps in behavioral health and substance use services.
But the work quickly raised a broader question:
Could the region improve access by better connecting the services and providers it already had?
RPP worked with CICS and its provider network to evaluate existing clinical pathways, identify barriers to collaboration, clarify expectations among organizations, and develop a more coordinated approach to helping individuals reach appropriate care.
Over approximately 18 months, the project evolved from consideration of a physical access center into development of a broader Virtual Access Center network grounded in shared principles, clinical pathways, provider relationships, and a “no wrong door” philosophy.
The System Challenge
CICS had a broad network of organizations providing behavioral health, substance use, disability, crisis, hospital, and community-based services.
But having services available did not necessarily mean they functioned as a coordinated system.
Providers identified several recurring challenges:
- “Working together” was not clearly defined
- Communication across organizations was inconsistent
- Individuals could end up at the wrong level of care
- Referrals within the existing network were underused
- Services could be duplicated
- Providers lacked shared information and meaningful data
- Systems and organizational processes remained disconnected
- Organizations did not always understand how to use one another’s strengths
The original project contemplated whether a physical access center could help address some of these gaps.
Stakeholder engagement revealed something more fundamental:
The greatest opportunity was not simply creating another place for people to go. It was improving how the existing system worked together.
Rural Policy Partners’ System Design Approach
Rather than beginning with a predetermined solution, RPP used an iterative process that allowed the model to evolve as providers identified needs, barriers, and opportunities.
Collaborative System Assessment
RPP facilitated regional provider meetings, organization-specific discussions, and community engagement to understand how individuals actually moved through the system.
The work examined:
- Existing services and levels of care
- Referral and transition processes
- Organizational roles and capabilities
- Policy and procedural barriers
- Gaps in communication
- Opportunities for greater coordination
Defining Collaboration
The project moved beyond the general idea that providers should “work together.”
Participating organizations developed shared expectations for collaboration through a provider memorandum of understanding and guiding principles.
Those commitments were then translated into practical tools and processes, including clinical pathway mapping, multi-party releases of information, provider resources, and strategies for staff training.
Designing a Network Without Four Walls
As the work progressed, the access center concept shifted away from a single physical location.
Instead, CICS and its partners began developing a network in which multiple organizations could function as access points into a coordinated continuum of care.
The goal became creating a system where individuals could enter through different doors while still being connected to the right care, at the right level, at the right time.
System-Level Insight
A pivotal shift occurred when the project moved from asking:
“Where should the access center be?”
to:
“How should the entire provider network function as an access system?”
That reframing changed the focus from a building to the connections between organizations.
The emerging Virtual Access Center model emphasized shared responsibility for helping individuals navigate the continuum rather than expecting individuals and families to determine where to go next on their own.
The project demonstrated an important system-design principle:
Access is not simply about having services available. It is about creating reliable pathways between those services.
OASIS: Collaboration for Complex Needs
One significant outcome of the project was the development of OASIS: Optimizing Access to Services and Integrated Support.
OASIS emerged from provider discussions about individuals whose needs crossed organizational and service-system boundaries.
The process was designed to support situations where an individual:
- Had needs beyond what one provider could address alone
- Was at risk of leaving the community for services without a clear plan to return
- Needed involvement from multiple service systems
- Required a transition to a more appropriate level of care
- Was returning to the community with complex support needs
Rather than simply making another referral, OASIS created a structured process for bringing relevant organizations together to review the situation, identify additional resources or approaches, and coordinate next steps.
The model reflected the broader philosophy of the project:
Complex needs should trigger greater collaboration, not another disconnected handoff.
Outcomes & Impact
Defined Regional Collaboration
Participating providers developed a shared memorandum of understanding and guiding principles that established clearer expectations for communication, collaboration, and coordinated care.
Shared Tools and Clinical Pathways
The project produced infrastructure that providers could use across organizational boundaries, including:
- Multi-party releases of information
- Clinical and process maps
- A documented continuum of care
- Regional provider contact and service resources
- Processes for improving referrals and transitions
- The OASIS collaborative review process
Stronger Provider Connections
The work created opportunities for providers to better understand one another’s services, limitations, strengths, and roles within the larger continuum.
Collaboration increasingly moved from informal relationships toward shared processes and expectations.
Early Operational Results
Participating hospitals reported increased emergency department diversions and faster transitions to appropriate care, contributing to reduced emergency department waits and holds.
Iowa’s subsequent transition to a new behavioral health administrative structure brought the CICS initiative to a close before formal outcome data could be systematically collected and analyzed.
As a result, the project’s strongest documented impact is reflected in the collaborative infrastructure, provider relationships, shared processes, and practice changes established across the network.
Why the CICS Experience Matters
Communities often focus on adding programs, facilities, or services when access problems emerge.
Sometimes those investments are necessary.
But the CICS experience demonstrates that gaps can also exist between existing resources.
Who makes the connection?
Who owns the transition?
What information follows the individual?
What happens when one organization reaches the limits of what it can provide?
And who brings providers together when an individual’s needs cross organizational boundaries?
CICS and its provider partners worked to build the infrastructure necessary to answer those questions collectively.
The project evolved from evaluating where services should be located to designing how services should connect.
That shift created the foundation for a more coordinated, person-centered network in which access depended less on finding the correct door and more on ensuring that every door could connect people to the care they needed.
About Rural Policy Partners
Rural Policy Partners works alongside states, health systems, and community leaders to bring structure to complex behavioral health systems.
We specialize in:
- Cross-sector facilitation
- Rural system design
- Clinical pathway and continuum development
- Translating stakeholder input into actionable strategy
Our work is grounded in real-world conditions, where policy, operations, organizational relationships, and community needs intersect.
Through its work with Central Iowa Community Services, Rural Policy Partners helped move a regional provider network from the concept of collaboration toward the structures and processes needed to make collaboration operational.