OnTrackNY: A public sector learning healthcare system for youth and young adults with early psychosis.

Coordinated Specialty Care is a treatment model for youth and young adults experiencing early psychosis. OnTrackNY, an internationally recognized public sector learning healthcare system, operates 31 coordinated specialty care teams throughout New York State with oversight from an intermediary organization, OnTrack Central. As part of the National Institute of Mental Health Early Psychosis Intervention Network initiative, OnTrackNY utilizes a stakeholder engagement unit and a data science unit to support quality improvement. This article describes how OnTrack Central uses the Institute of Medicine's Group Health Cooperative learning healthcare system framework and learning loop approach to enhance racial equity in OnTrackNY through a multi-component quality improvement project. Qualitative interviews (N = 70) with OnTrackNY participants, families, and providers revealed experiences with racism and shared decision making and identified stakeholder-driven modifications to OnTrack Central's training and implementation approach. Modifications included stakeholder co-created shared decision making training modules for providers and ethnoracially minoritized participants, and a provider learning collaborative to promote shared decision making with ethnoracially diverse participants and families. Evaluation of the modules and collaborative identified barriers including limited time for providers to engage with training and a lack of confidence among trainers in delivering racial equity trainings. Results highlighted the need to adjust content and develop two workforce training programs focused on enhancing shared decision making along the continuum of OnTrackNY care. This article demonstrates how a public sector learning healthcare system can use a stakeholder-partnered approach to enhance the competency of coordinated specialty care workforce and promote equitable and data-driven care.