Status Report on CalMHSA Statewide Prevention and Early

Intervention ProgramsCalifornia Social Work Education

Center

February 6, 2014

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

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Presentation Goals

• Introduction to CalMHSA• Status Report on Program

Implementation– Suicide Prevention (SP)– Stigma and Discrimination Reduction

(SDR)– Student Mental Health (SMH)

• Early Evaluation Findings• Q & A

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CalMHSA Mission

• Provide member counties a flexible, efficient, & effective administrative/fiscal structure focused on collaborative partnerships & pooling efforts in: – Development & Implementation of Common Strategies &

Programs– Fiscal Integrity, Protections, & Management of Collective

Risk– Accountability at State, Regional & Local Levels

• Current MHSA funds administered by the JPA:– Prevention & Early Intervention (PEI) Statewide Funds

(Suicide Prevention, Stigma & Discrimination Reduction, Student Mental Health)

– Training, Technical Assistance & Capacity Building– Workforce, Education & Training

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• PEI 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.

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PEI Programs at a Glance

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What are We Trying to Accomplish? Evaluation

Framework

STRUCTURE

What PEI capacities & resources are Program

Partners developing and implementing?

•Networks•Needs assessment•Service expansion•Outreach•Training & technical assistance•Screening•Educational resources•Marketing campaigns•Cross-system collaboration•Policies & protocols

PROCESS

What intervention activities are delivered,

and to whom?

•Participation in training & education•Exposure to outreach•Exposure to media•Access to and use of services •Quality and cultural appropriateness of services

SHORT TERMOUTCOMES

What are immediate targets of change?

•Knowledge•Attitudes•Normative behavior•Mental & emotional well-being•Help-seeking

KEYOUTCOMES

What negative outcomes are

reduced?

•Suicide•Discrimination•Social Isolation•Student failure/disengagement

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Where is it going?

What is it doing?

Does it make a difference?

Are there public health benefits?

Did it increase other community supports

and resources?

Individual Change

Social Change

Policy/Practice Change

Change in knowledge,

attitudes and behaviors

Shifts in community discussions,

media portrayals, and norms

Change in laws, policies, and practices

Policies, Protocols, Procedures

Networking and Collaboration

Informational Resources

Training and Education

Media Campaigns

Hotline/Warmline Operations

Initiatives SP, SDR, and SMHOutcomes at Each Level of Change

Multi-Level Interventions are thought to be most Effective

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Interim Evaluation Progress Report

• Baseline assessments of population risk factors and outcomes

• Suicide rates in California• Statewide survey of general population• Higher 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 California

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Baseline Assessment:Statewide Survey of General

Population• Goals:

– Primary: Serve as a baseline measure of general population risk factors

– Secondary: 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 adults– Sample closely matches general population on sex, age,

race, ethnicity, education, income, and employment

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• Awareness– 73% agree that “people with mental illness experience high

levels of prejudice and discrimination”

• Social Distance– 34% report being “unwilling to move next door” to someone with

serious mental illness– 29% report being “unwilling to work closely on a job” with

someone with a serious mental illness

• Perceived Dangerousness– 1 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 Results

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Baseline Assessment:Statewide General Population Results

• Disclosure– 42% report probably or definitely concealing a mental

health problem from coworkers or classmates • Suicide Knowledge

– While 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 true

– 34% 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 professionals

• Resources developed: www.eachmindmatters.org, www.walkinourshoes.org & www.ponteenmiszapatos.org; and enhanced www.reachouthere.com & www.buscaapoyo.com

Examples of SDR Capacities Developed

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Compassion. Action. Change.Compassion. Action. Change.Compassion. Action. Change.13

Tools for Everyone Compliment Catcher

Dice of Wellness

I identify with Ethan because I have ADHD, and it doesn’t 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 Modesto

The 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

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Compassion. Action. Change.Compassion. Action. Change.Compassion. Action. Change.14

Highlights 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.

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The Stigma and Discrimination Reduction Legacy

Disability Rights California• 31 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 Developed

Hotlines/Warmlines:– Established a new hotline in the Central Valley– Established crisis chat/text counseling– Expanded Spanish, Vietnamese, Korean

language services– Increased services to underserved populations– Trained the community in ASIST & safeTALK

Statewide Call Volume of the 10 Crisis Centers Participating in the Common Metrics ProgramMonth June July Aug Sept OctVolume 21,586 22,689 28,248 22,433 21,783

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Compassion. Action. Change.Compassion. Action. Change.Compassion. Action. Change.17

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

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The Suicide Prevention Legacy

• Common Metrics Project:o Develop standardized data collection across

11 crisis centers in California.o Identify trends and gaps in crisis center

utilization

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Compassion. Action. Change.Compassion. Action. Change.Compassion. Action. Change.19

Engaging Students in Educating Californians

Suicide Prevention Category

1st Place: Angel Lopez

Eliminating Stigma Category

1st 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

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• Pre-K-12 – County Consortia to promote best practices and provide training for educators, online clearinghouse www.regionalk12smhi.org– State policy workgroup resulted in credentialing

standards– “Training Educators Through Recognition and

Identification Strategies” (TETRIS) and Training for Trainers (TOT)

• Higher Education– Cross-campus advisory and collaborative groups– Online resources for faculty, staff & students – Trainings for faculty, staff, and students on suicide

prevention/recognizing and responding to signs of distress

Examples of SMH Capacities Developed

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Compassion. Action. Change.Compassion. Action. Change.Compassion. Action. Change.21

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 practices•2,667 site visits from September 2012 to March 2013•82% of visits were from other education-institution sites

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The 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

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Investments to Reduce Disparities

• Developed 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 NAMI’s In Our Own Voice Program• Specialized 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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• Program Partners have been highly productive in developing building capacities

• Early information on reach is promising• Short-term impacts cannot yet be determined • Population-based surveys and suicide statistics

provide baseline information for longer-term tracking

• Implementation of statewide, population-focused PEI strategy is challenging and ground-breaking

• Evaluation approaches and tools may be useful for county-level PEI efforts

Evaluation Conclusions to Date

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What’s Available

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

• RAND Interim Evaluation Publications• Suicide Prevention Fact Sheet• Stigma and Discrimination Reduction Fact She

et• Student Mental Health Fact Sheet• Executive Summary• Suicide Prevention Summary• Stigma and Discrimination Reduction Summar

y• Student Mental Health Summary

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Evaluation Timeline

2016

Dissemination of RAND interim findings

RAND Reducing Disparities Report

Long-term sustained impact monitored

Individual program evaluation data/reports

New contracts*Contract monitoring quality improvement implementation

RAND Short-term outcome reports Factsheets Briefs

2015

Quarterly Program and Cost Reporting (4x a year)

Quarterly Program and Cost Reporting (4x a year)

2014

RAND Long-term outcome reports and findings Factsheets Briefs

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• Very important studies of short-term outcomes (Summer 2014)

• Completion of baseline population studies– K-12 surveys– Mental health supplemental survey

• Ongoing evaluation of capacity development and reach

• Long-term outcomes assessed (Summer 2015)

Evaluation Next Steps

Visit www.CalMHSA.org for up-to-date information and resources.

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Q & A

Stephanie Welch, MSWCalMHSA Senior Program

ManagerStigma and Discrimination

ReductionStephanie.welch@calmhsa.org

(916) 859-4816www.calmhsa.org

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Ann Collentine, MPPACalMHSA Program Director

Student Mental HealthAnn.Collentine@calmhsa.org

(916) 859-4806www.calmhsa.org

Sarah Brichler, MEdCalMHSA Program

ManagerSuicide Prevention

Sarah.brichler@calmhsa.org

(916) 859-4827

www.calmhsa.org