Campaign

Steering Committee

Friday, September 28

9-3 pm

Roseville

• Welcome• Consumer Voice• Public Comment• Update on Community

Support Services Funding

• Prevention/Intervention– California Institute for

Mental Health - Lynne Marsenich

• Framework for PEI• Group work

– Identify needs

Agenda

.

VOICE

Public Comment

Comments Welcome

3-minutes per comment

Update on Community Services and Supports Funds

AB2034 One-time monies

Impact to your recommendation

CrisisTriage

Steering Committee

Transition AgeYouth

AdultOlder Adult

Lake Tahoe

Children

SystemChange

Co-occurring/Cultural Comp.

SED,SMI Children, Youth & Adults, O.AdultsLatino, TAY, Native American

VoiceMH & SMART

BoardVoice/Direction

System Transformation

Full-servicePartnerships

Youth Consumer Family

Recommendation #1Contingency Plan

(no AB2034)

Homeless

10% - $88k

90% - $793k 100% - $880k

0% - $0

CrisisTriage

Steering Committee

Transition AgeYouth

AdultOlder Adult Lake TahoeChildren

SystemChange

Co-occurring/Cultural Comp.

Children, Youth & Adults, O.AdultsLatino, TAY, Native American

VoiceMH & SMART

BoardVoice/Direction

System Transformation

Full-servicePartnerships

Youth Consumer Family

Recommendation #2:Sent to State As Is

15% - $132k

15% - $132k

10% - $88k60% - $529kSeverely Emotionally DisturbedSeverely Mentally Ill

Lake Tahoe

CommunityService & Supports

Planning processes underway

Early Intervention &

Prevention

No guidelines yetLimited Information

Phase 1$2.2M for 3 years

New money: + $881K

Technology

Workforce Development

Housing

InnovativePrograms

MHSA Funding Plans (6)

Facilities & Infrastructure

Prevention and Early Intervention

Where we are in the planning process

Review State Guidelines

California Institute for Mental Health training

Review: PEI Planning Process

Submit PlanSteering Committee

Approval

Planning

• Staff operationalizes recommendations into Plan (work plan)

• Public comment period on PEI Plan (30 days)

• Public Hearing

• Comments incorporated into plan (w/ Steering response)

• Steering committee comments

• Ranking of prioritized plans

• Recommendations for funding are formalized*

•Only top priorities are selected

• Research & Understand Models

• Identify Needs

• Inventory Community Assets, map to data

• Create Plans

Facilitator &Staff Support

California Institute of Mental Health

Prevention and Early Intervention:A Framework for Decision-Making

Lynne Marsenich, LCSWSenior Associate

Prevention & Intervention DollarsGuidelines

Target Populations• All age groups

– 51%, 0-25yrs

• Underserved cultures• Indiv.w/early onset of mental

illness• Trauma exposed• Children/youth :

– In stressed families– At risk of school failure– At risk of juv. justice

Key StrategiesDisparity in access to mental health servicesPsycho-social impact of traumaAt-risk children, youth, young adultsStigma discriminationSuicide risk

Prevention & Intervention DollarsGuidelines

Long-Term OutcomesReduce:• School failure• Homelessness• Long-term suffering• Unemployment• Incarceration• Removal from home (children)• Suicide

Partners:Collaboration & community partnerships SchoolsPrimary careFaith-basedHealersEarly childhood ed.Youth-at-risk programs

Prevention & Intervention DollarsGuidelines

Statewide Support• Suicide prevention• Anti-stigma• Project training, tech.

assistance, capacity building• Ethnically & culturally

specific programs & interventions

Short-term goals,Evaluation, AccountabilityPlan must provide short-term goals with accountability measures5-8% of County PEI funds must be spent on evaluation

Out of MHSA Admin budget (not PEI)

Prevention and Early Intervention: Definitions

Levels of prevention proposed by the Institute of Medicine and adopted by the state department of Mental Health– Universal Preventive Interventions

– Selective Preventive Interventions

– Indicated Preventive Interventions

Definitions

Universal preventive interventions– Interventions targeted to a whole population

that has not been identified on the basis of individual risk. The intervention is seen as desirable for everyone

– Examples: drug and alcohol prevention programs in schools

• Mass media campaigns

Definitions

Selective preventive interventions– Interventions targeted to individuals in a subgroup

of the population whose risk of developing mental disorders is significantly higher than average. The risk may be imminent or it may be a life time risk

– Examples: Depression screening in senior citizens centers

• Mentoring programs for children with school performance problems

Definitions

Indicated preventive interventions– Interventions targeted to high risk individuals who are

identified as having detectable signs or symptoms foreshadowing mental disorders but who do not meet DSM criteria levels at the current time or who are engaging in high risk behaviors

– Example – Short term trauma interventions for the victims of Hurricane Katrina

• Children and adults who witness community violence

Risk and Protective Factors

• All prevention programs begin with an understanding of factors that place people at risk for or protect them from emotional and behavioral problems including mental disorders

• Risk factors are any circumstances that may increase an individual’s likelihood of engaging in risky behavior or developing a mental health problem

• Protective factors are any circumstances that reduce the likelihood that a behavior or mental disorder will develop

Risk and Protective Factors

• Risk and protective factors exist at every level at which an individual interacts with others and the society around him or her

• Risk and protective factors six life or activity domains– Individual– Peer– Family– School/Workplace– Community/Neighborhood– Society/Environment

Individual

• Biological and psychological dispositions

• Attitudes• Values• Knowledge• Skills• Problem behaviors such as truancy or

criminal behavior or alcohol abuse

Peer

• Norms

• Activities

• Bonding

• Social Support

• Psychological Safety

Family

• Parenting disciplinary practices

• Emotional climate

• Family living situation

• Mutually reinforcing relationships

School/Workplace

• School– Bonding– Climate– Policy– Performance

• Workplace– Stress– Alienation from work– Climate– Organizational culture

Community

• Bonding

• Norms

• Resources

• Awareness/mobilization

Society

• Norms

• Policies

• Health promotion activities

Risk and Protective Factors

• The domains are not static in their impact

• Interaction and change over time

• Take home message: choose interventions that target specific risk factors and build up protective factors

Utilizing a risk & protective factor framework

• Prevention Target – Suicide• Risk factors

– Mental disorders particularly depression, bipolar and schizophrenia– Alcohol or other substance abuse – Historical trauma, history of trauma or abuse– Some major physical illnesses– Previous suicide attempt– Family history of suicide– Gay and Lesbian youth– Native American youth– Elderly– Girls and young women

Suicide: Risk and Protective Factors

Risk factors– Job loss– Relational or social loss– Easy access to lethal means– Local clusters of suicide that have a contagious

influence– Lack of social support and sense of isolation– Discrimination– Exposure to, including through the media, and

influence of others who have died of suicide

Suicide: Risk and Protective Factors

• Protective Factors– Strong connections to family and community

support– Enculturation

• Positive ethnic identity• Participation in traditional cultural practices

– Restricted access to highly lethal means of suicide – Problem-solving, conflict resolution and anger

management skills

Suicide: Risk and Protective Factors

• Protective Factors– Cultural and religious beliefs that discourage

suicide and support self preservation

– Easy access to a variety of clinical interventions and support for help seeking

– Quality health care

Suicide

• Target Population (s)– Elderly

– Girls and young women

– Gay and Lesbian youth

– Adults with serious mental disorders

– Native American youth

Suicide

• Level of intervention– Universal

• School based suicide prevention curriculum• Depression screening in senior citizen centers• Community- wide public health campaigns

– Selected• Care management program for the elderly

Suicide

• Locus of intervention– Primary care clinic

– School

– Emergency room

– Boys and Girls clubs, YWCA, YMCA

– Faith based activity and or social clubs

Evidence-Based Practices

• “…the integration of the best research evidence with clinical expertise and patient (consumer) values”

• Based on the definition used in “Crossing the Quality Chasm: A New Health System for the 21st Century” (2001), by the Institute of Medicine

Evidence-Based Practices

• Clinician expertise and judgment based on education and experience

• Consumer and family beliefs, values, preferences, choices based on personal life experience, family, and culture

• Effectiveness research based on controlled studies

Levels of Science

• Effective/Efficacious--achieves outcomes, controlled rigorous research (random assignment, matched between-groups comparisons)

• Not effective--significant evidence of a null, negative, or harmful effect

• Promising--some positive research evidence, quasi-experimental, of success and/or expert consensus

• Emerging practice--recognizable as a distinct practice with “face” validity or common sense test

• Unknown--not clearly articulated nor evaluated

Evidence-Based Practices

• Specific to area of need or concern• Specific to outcomes achieved• Clearly articulated practices--can be

replicated• EBPs are not always effective• Incorporation of EBPs is a

developmental process of building on successive advances--it is not an end but a beginning

Evidence-Based Practices

• Increase hope• Increase choice• Increase individualized care• Improves achievement of outcomes• Reduces adverse consequences of

inappropriate care• Achieves outcomes sooner• Outcomes last longer• Ethical• Cost effective

Selecting an Evidence Based Practices

• What outcomes do you want to achieve• For whom?• EBPs are specific to outcome and population• What is the level of evidence?• Need to know the research methodology• Higher levels mean more confidence that if

implemented in your community (with high model adherence) similar good outcomes will be achieved.

• Consider lower levels of science when there is no alternative at a higher level, or interested in a practice-to-science program.

• Be cautious of promotion in advance of research

Questions?

Group Planning

ID Community Needs for

Prevention & Early Intervention

Prioritization Process

SteeringCommunity

(Tahoe)Community(Roseville)

Community(Lincoln)

ID Needs

Prioritize (5)

SteeringPrioritize needs (3)

Asset Mapping Community

Program PrioritiesStrategies

Approval

Breakout Session TodayOverview

• Divide into 3-4 groups• What are our community needs for prevention

& early intervention?– Individual

– Share with small group

– Consensus around 5 (if possible)

– Top 7 on half sheets

• Share with group• Prioritize to get to top 5

Close

• Thank you

• Next meeting: Nov 30th

• Notes will be posted on web

• Meeting evaluation: thank you