Status Report on CalMHSA Prevention and Early Intervention Programs

Status Report on CalMHSA Statewide Prevention and Early Intervention ProgramsCalifornia Social Work Education Center

February 6, 2014Stephanie Welch, MSW, Senior Program ManagerCalifornia Mental Health Services Authority (CalMHSA)

11Presentation Goals Introduction to CalMHSAStatus Report on Program ImplementationSuicide Prevention (SP)Stigma and Discrimination Reduction (SDR)Student Mental Health (SMH)Early Evaluation FindingsQ & A22CalMHSA MissionProvide member counties a flexible, efficient, & effective administrative/fiscal structure focused on collaborative partnerships & pooling efforts in: Development & Implementation of Common Strategies & ProgramsFiscal Integrity, Protections, & Management of Collective RiskAccountability at State, Regional & Local LevelsCurrent MHSA funds administered by the JPA:Prevention & Early Intervention (PEI) Statewide Funds (Suicide Prevention, Stigma & Discrimination Reduction, Student Mental Health)Training, Technical Assistance & Capacity BuildingWorkforce, Education & Training33PEI programs should: Be designed to prevent mental illnesses from becoming severe and disabling. Reach out to families, primary health providers, and others to recognize the early signs of potentially severe and disabling mental illness. Increase or make accessible, linkage to services of children and adults who are experiencing early onset of these conditions. Reduce the stigma associated with being diagnosed or seeking mental health services.Incorporate existing best practices used to intervene and reduce the duration of untreated mental illness, and assist people in quickly regaining a productive life. 2PEI Programs at a Glance4Specifically, the Mental Health Services Act PEI programming focus emphasizes the reduction of negative outcomes. These are:SuicideIncarcerationsSchool failure or dropoutUnemploymentProlonged sufferingHomelessnessRemoval of children from their home4What are We Trying to Accomplish? Evaluation FrameworkSTRUCTURE

What PEI capacities & resources are Program Partners developing and implementing?

NetworksNeeds assessmentService expansionOutreachTraining & technical assistanceScreeningEducational resourcesMarketing campaignsCross-system collaborationPolicies & protocols

PROCESS

What intervention activities are delivered, and to whom?

Participation in training & educationExposure to outreachExposure to mediaAccess to and use of services Quality and cultural appropriateness of services

SHORT TERMOUTCOMES What are immediate targets of change?

KnowledgeAttitudesNormative behaviorMental & emotional well-beingHelp-seeking

KEYOUTCOMES

What negative outcomes are reduced?

SuicideDiscriminationSocial IsolationStudent failure/disengagement

5Where is it going?What is it doing?Does it make a difference?Are there public health benefits?Did it increase other community supportsand resources?5Change in knowledge, attitudes and behaviorsShifts in community discussions,media portrayals, and normsChange in laws, policies, and practicesPolicies, Protocols, ProceduresNetworking and CollaborationInformational ResourcesTraining and Education Media CampaignsHotline/Warmline OperationsInitiatives SP, SDR, and SMHOutcomes at Each Level of Change

Multi-Level Interventions are thought to be most Effective

66Interim Evaluation Progress Report

Baseline assessments of population risk factors and outcomes

Suicide rates in CaliforniaStatewide survey of general populationHigher education surveys (in progress)

Early data on reach of activities

Key documents available at: www.calmhsa.org/programs/evaluation

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2008-2010: Highest risk of suicide noted for less dense, Superior Region of CA

Highest numbers of suicides in more population dense counties:Los Angeles (2,358 suicides)San Diego (1,072 suicides)Orange (809 suicides)San Bernardino (649 suicides)Riverside (611 suicides)

Baseline Assessment:Suicide Rates in California88Baseline Assessment:Statewide Survey of General PopulationGoals:Primary: Serve as a baseline measure of general population risk factorsSecondary: Early measure of exposure to CalMHSA PEI efforts.Where possible, survey items were based on other large, population-based surveys.Survey Respondents:2,001 California adultsSample closely matches general population on sex, age, race, ethnicity, education, income, and employment

9Awareness73% agree that people with mental illness experience high levels of prejudice and discriminationSocial Distance34% report being unwilling to move next door to someone with serious mental illness29% report being unwilling to work closely on a job with someone with a serious mental illnessPerceived Dangerousness1 in 5 reported that violence towards others was somewhat or very likely for people with depression or PTSD, while nearly half thought so for people with schizophrenia

Baseline Assessment:Statewide General Population Results10Baseline Assessment:Statewide General Population ResultsDisclosure42% report probably or definitely concealing a mental health problem from coworkers or classmates Suicide KnowledgeWhile two-thirds of Californians generally think suicide is preventable, lack of knowledge seems greater in two groups * Californians between 50-64 years of age * Black/African Americans 54% think there are always warning signs before a suicide is true34% think women are more at risk of suicide than men is false

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Toolkits and resources for various audiences (e.g., journalists, fact sheets on legal rights & responsibilities, Integrated Behavioral Health Toolkit)Trainings and educational programs for diverse audiences:People with mental health challenges and their families, landlords, health providers, law enforcement, public defenders, employers, teachers and students, un/underserved populations, media training for journalism and entertainment professionalsResources developed: www.eachmindmatters.org, www.walkinourshoes.org & www.ponteenmiszapatos.org; and enhanced www.reachouthere.com & www.buscaapoyo.com Examples of SDR Capacities Developed12Tools for Everyone Compliment CatcherDice of Wellness

I identify with Ethan because I have ADHD, and it doesnt matter what mental health challenge you have because everyone is unique in their own way and it just adds to who you are. Student in ModestoThe performance is great. The kids were singing the songs and a few were still singing them as they exited. The play fits right into our bully prevention curriculum. School Psychologist, Chico Unified School District I relate to having fear and anxiety and it can get to me sometimes. Student in San Francisco I have PTSD, and I go to counseling and it helps Student in Red Bluff, CA

Thank you everyone so much for all the kind words! It means a lot to have a community that shows this much support. I don't even know any of you personally but I still feel like I'm not alone in this.guys thanks for the help i have no idea where i would be if i hadnt discovered this site earlier this year.

Highlights of the Stigma and Discrimination Reduction Social Marketing Campaign: Youth 13Compassion. Action. Change.

Compassion. Action. Change.

Compassion. Action. Change.#

The Walk in Our Shoes Campaign targets California youth ages 9-13. In addition to downloadable tools and an interactive website, the campaign included school-based performances which educated youth about stigma related to mental illness. During its tour, the performances reached over 18,000 kids in 52 performances across the state.

In partnership with Inspire USA, the ReachOutHere Forums provide online and now text support to youth age 14-24. As of December 31, 2013, there have been 209,224 unique visits.

13Highlights of the Stigma and Discrimination Reduction Social Marketing Campaign: Adults

I make a pledge that when anyone with living mental health experiences reaches out their hand for help, I will be there as a peer. With patience, understanding, kindness & love. Linda M.

14Compassion. Action. Change.

Compassion. Action. Change.

Compassion. Action. Change.#

Californias Mental Health Movement, Each Mind Matters, launched in May of 2013. As of December 31, 2013 29,579 people have visited the website, which includes links to the SDR documentary: A New State of Mind: Ending the Stigma of Mental Illness, which as been viewed 8,367 times since June 2013. Additional features of the EMM website include a place for visitors to make a pledge to stomp out stigma in their enivornments. As of December 2013, 389 people have made pledges and joined the movement. 14The Stigma and Discrimination Reduction Legacy

Disability Rights California31 fact sheets have been developed on a myriad of topics. 21 of these fact sheets have been translated into 14 languages. 47 trainings, which reached 1,430 people, have been completed statewide. Analysis of existing law, to identify legislation that contributes to stigma and discrimination, then sent forward with recommendations on next steps.

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Social Marketing www.suicideispreventable.org, www.elsuicidioesprevenible.org Developed: television and radio spots, billboards, a media outreach toolkit, suicide prevention posters and brochures, websites; Your Voice Counts forum; Directing Change contest. Developed MY3 safety planning app: www.my3app.org

Examples of SP Capacities DevelopedHotlines/Warmlines:Established a new hotline in the Central ValleyEstablished crisis chat/text counselingExpanded Spanish, Vietnamese, Korean language servicesIncreased services to underserved populationsTrained the community in ASIST & safeTALKStatewide Call Volume of the 10 Crisis Centers Participating in the Common Metrics Program

MonthJuneJulyAugSeptOctVolume21,58622,68928,24822,43321,7831616

Highlights of the Suicide Prevention Social Marketing Campaign: Know the Signs

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Compassion. Action. Change.

Compassion. Action. Change.

Compassion. Action. Change.#

Objectives of the Pathways to Purpose and Hope Program:Readers of Pathways to Purpose and Hope will have increased:1. Knowledge of the steps to establish and/or expand a sustainable survivor support program.2. Understanding of the critical elements and services for a sustainable program.3. Knowledge of training and other resources available to support their efforts.

17The Suicide Prevention Legacy

Common Metrics Project:Develop standardized data collection across 11 crisis centers in California.Identify trends and gaps in crisis center utilization

18A Suicide Prevention mobile app. AdEase is working with the National Suicide Prevention Lifeline and the Santa Clara Suicide Prevention Initiative to create the framework for the app.

Target Audience: Those at-risk for suicide

Cost: Free

Purpose: Getting a person at risk connected to their primary support network when they are in crisis; also provides safety planning and other helpful resources.

Release in California in October 2013, will be released nationally in June 2014.18Engaging Students in Educating CaliforniansSuicide Prevention Category1st Place: Angel Lopez

Eliminating Stigma Category1st Place: Spencer Wilson

This was one of the best experiences of my life. To see the amazing amount of talent in our state was nothing short of awesome. It was so hard to judge the videos because they all had some unique aspect that makes them winners. I hope that this is not the last time that we offer this opportunity to our students in California. There is so much more talent and so many more stories that still need to be seen and heard. This was a fantastic way to integrate our schools into a worthy statewide cause. Judge, Directing Change

19Compassion. Action. Change.

Compassion. Action. Change.

Compassion. Action. Change.#

If you click on the individual picture, it will play the PSA (you will need to turn the volume up for the SP video, but NOT for the SDR video)19Pre-K-12 County Consortia to promote best practices and provide training for educators, online clearinghouse www.regionalk12smhi.orgState policy workgroup resulted in credentialing standardsTraining Educators Through Recognition and Identification Strategies (TETRIS) and Training for Trainers (TOT)Higher EducationCross-campus advisory and collaborative groupsOnline resources for faculty, staff & students Trainings for faculty, staff, and students on suicide prevention/recognizing and responding to signs of distressExamples of SMH Capacities Developed

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Red Folder Initiative (targets faculty/staff) To date, more than 20,000 have been distributed on UC Campuses. To date, 48,000 students have been screened for depression and suicidal ideation.

Highlights Available Resources

Create interactive online statewide clearinghouse of resources and best practices2,667 site visits from September 2012 to March 201382% of visits were from other education-institution sites

21Compassion. Action. Change.

Compassion. Action. Change.

Compassion. Action. Change.#

University of CA have red folders that contain information that are given to all staff to help recognize and help students with mental illnesses.

Click the Red Folder to play the Veterans PSA21The Student Mental Health Legacy

The SMHPW first recommendation supported the inclusion of mental health curriculum for all future educator credentialing programs. The California Teacher Credentialing Commission on September 26, 2013 approved future administrator credential programs must include content knowledge on: Culturally responsive, research-based, student centered classroom management and school wide positive discipline intervention and prevention strategies that address the social and mental health needs of the child 22Compassion. Action. Change22Investments to Reduce DisparitiesDeveloped Culturally Adapted/Responsive SDR and SP social marketing campaign efforts In-language materials and recent launch of Sana Mente (Spanish Language Each Mind Matters)Cultural Adaption of NAMIs In Our Own Voice ProgramSpecialized Programs for Youth Two-Way Texting Crisis and Support and Peer to Peer in Higher Education Cultural Responsiveness Training and TA for Program Partners Partnership with CRDP contractors on cultural considerations in SDR, SP and SMH efforts

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23Program Partners have been highly productive in developing building capacitiesEarly information on reach is promisingShort-term impacts cannot yet be determined Population-based surveys and suicide statistics provide baseline information for longer-term trackingImplementation of statewide, population-focused PEI strategy is challenging and ground-breakingEvaluation approaches and tools may be useful for county-level PEI efforts

Evaluation Conclusions to Date24Whats AvailableKey documents available at: www.calmhsa.org/programs/evaluation RAND Interim Evaluation PublicationsSuicide Prevention Fact SheetStigma and Discrimination Reduction Fact SheetStudent Mental Health Fact SheetExecutive SummarySuicide Prevention SummaryStigma and Discrimination Reduction SummaryStudent Mental Health Summary

252526Evaluation Timeline2016Dissemination of RAND interim findingsRAND Reducing Disparities ReportLong-term sustained impact monitoredIndividual program evaluation data/reportsNew contracts*Contract monitoring quality improvement implementationRAND Short-term outcome reportsFactsheetsBriefs2015Quarterly Program and Cost Reporting (4x a year)Quarterly Program and Cost Reporting (4x a year)2014RAND Long-term outcome reports and findingsFactsheetsBriefs2626Very important studies of short-term outcomes (Summer 2014)Completion of baseline population studiesK-12 surveysMental health supplemental survey Ongoing evaluation of capacity development and reachLong-term outcomes assessed (Summer 2015) Evaluation Next StepsVisit www.CalMHSA.org for up-to-date information and resources.2728

28Q & AStephanie Welch, MSWCalMHSA Senior Program ManagerStigma and Discrimination ReductionStephanie.welch@calmhsa.org (916) 859-4816www.calmhsa.org 29Ann Collentine, MPPACalMHSA Program DirectorStudent Mental HealthAnn.Collentine@calmhsa.org (916) 859-4806www.calmhsa.org Sarah Brichler, MEdCalMHSA Program ManagerSuicide PreventionSarah.brichler@calmhsa.org (916) 859-4827www.calmhsa.org 29