Status Report on CalMHSA Statewide Prevention and Early Intervention Programs

1. Status Report on CalMHSAStatewide Prevention and Early Intervention Programs California Social Work Education Center February 6, 2014 Stephanie Welch, MSW, Senior Program Manager California Mental Health Services Authority (CalMHSA)

2. 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

3. 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

4. PEI Programs at a Glance 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. 2 4

5. What are We Trying to Accomplish? Evaluation Framework Does it make a difference? What is it doing? Are there public health benefits? Where is it going? • 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 • SHORT TERM • OUTCOMES • What are immediate targets of change? • Knowledge • Attitudes • Normative behavior • Mental & emotional well-being • Help-seeking • KEY • OUTCOMES • What negative outcomes are reduced? • Suicide • Discrimination • Social Isolation • Student failure/ • disengagement • 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 Did it increase other community supportsand resources?

6. Initiatives SP, SDR, and SMH Outcomes at Each Level of Change Change in knowledge, attitudes and behaviors Change in laws, policies, and practices Shifts in community discussions, media portrayals, and norms

7. 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

8. Baseline Assessment: Suicide Rates in California • 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)

9. 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

10. Baseline Assessment:Statewide General Population Results • 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

11. 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

12. Examples of SDR Capacities Developed • 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

13. Highlights of the Stigma and Discrimination Reduction Social Marketing Campaign: Youth I have PTSD, and I go to counseling and it helps – Student in Red Bluff, CA 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 I relate to having fear and anxiety and it can get to me sometimes. – Student in San Francisco 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 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 ihadnt discovered this site earlier this year. Tools for Everyone Compliment Catcher Dice of Wellness 13

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. 14

15. 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.

16. Examples of SP Capacities Developed 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 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

17. Highlights of the Suicide Prevention Social Marketing Campaign: Know the Signs 17

18. The Suicide Prevention Legacy • Common Metrics Project: • Develop standardized data collection across 11 crisis centers in California. • Identify trends and gaps in crisis center utilization 18

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 19

20. Examples of SMH Capacities Developed • 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

21. Highlights Available Resources • 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. • 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 21

22. 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 22

23. 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

24. Evaluation Conclusions to Date 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

25. 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 Sheet • Student Mental Health Fact Sheet • Executive Summary • Suicide Prevention Summary • Stigma and Discrimination Reduction Summary • Student Mental Health Summary

26. Evaluation Timeline • RAND Short-term outcome reports • Factsheets • Briefs • RAND Long-term outcome reports and findings • Factsheets • Briefs Long-term sustained impact monitored Dissemination of RAND interim findings RAND Reducing Disparities Report 2016 2014 2015 Quarterly Program and Cost Reporting (4x a year) Individual program evaluation data/reports New contracts *Contract monitoring quality improvement implementation Quarterly Program and Cost Reporting (4x a year) 26

27. Evaluation Next Steps Visit www.CalMHSA.org for up-to-date information and resources. • 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)

29. Q & A Ann Collentine, MPPA CalMHSA Program Director Student Mental Health Ann.Collentine@calmhsa.org (916) 859-4806 www.calmhsa.org Stephanie Welch, MSW CalMHSA Senior Program Manager Stigma and Discrimination Reduction Stephanie.welch@calmhsa.org (916) 859-4816 www.calmhsa.org Sarah Brichler, MEd CalMHSA Program Manager Suicide Prevention Sarah.brichler@calmhsa.org (916) 859-4827 www.calmhsa.org