rand’s recommendations for sustaining california’s statewide mental health prevention and early...

RAND’s Recommendations for Sustaining California’s Statewide

Mental Health Prevention and Early Intervention Programs

August 14, 2014

RAND’s Recommendations for Sustaining California’s Statewide

Mental Health Prevention and Early Intervention Programs

August 14, 2014

© Copyright 2014 RAND Corporation

• Does the activity fill a strategic gap? (e.g., not redundant with county-level efforts?)

• Does the activity employ population-based strategies that can only be feasibly implemented at the statewide level?

• Are there efficiencies in scale to be gained by statewide sustainment?

• Would a relatively low-cost investment in sustaining program operations yield value and leverage already-created capacities that required a much higher start-up cost investment?

• Would sustained programs have performance monitoring capacity integrated into them, so interventions can be improved over time?

• Would statewide efforts contribute to the development of valued local capacity?

• Does the activity fill a strategic gap? (e.g., not redundant with county-level efforts?)

• Does the activity employ population-based strategies that can only be feasibly implemented at the statewide level?

• Are there efficiencies in scale to be gained by statewide sustainment?

• Would a relatively low-cost investment in sustaining program operations yield value and leverage already-created capacities that required a much higher start-up cost investment?

• Would sustained programs have performance monitoring capacity integrated into them, so interventions can be improved over time?

• Would statewide efforts contribute to the development of valued local capacity?

Criteria for Value in SustainabilityCriteria for Value in Sustainability


• Recommendations for program activities that should be considered for sustainment are based on:

– Sustainability criteria– Literature reviews we conducted in each initiative area– RAND evaluation results to date

• Recommendations for program activities that should be considered for sustainment are based on:

– Sustainability criteria– Literature reviews we conducted in each initiative area– RAND evaluation results to date

Suggested Program Activities to SustainSuggested Program Activities to Sustain


• Social Marketing Campaign– Suggest sustaining EMM campaign and website, as

• Campaign impacts are short-lived unless continued • Evaluation results show promising reach of campaign

– CalMHSA should continue to target PEI efforts toward Asian Americans and Latinos.

• Evaluation shows that Asian Americans and Latinos interviewed in Spanish report relatively high levels of stigma

– Messaging targeting young adults should focus on how they can provide support to individuals with mental health concerns and link them to resources

• Evaluation results indicate that young adults are relatively less stigmatizing & more likely to know those with mental health challenges, but unlikely to help link them to resources

• Social Marketing Campaign– Suggest sustaining EMM campaign and website, as

• Campaign impacts are short-lived unless continued • Evaluation results show promising reach of campaign

– CalMHSA should continue to target PEI efforts toward Asian Americans and Latinos.

• Evaluation shows that Asian Americans and Latinos interviewed in Spanish report relatively high levels of stigma

– Messaging targeting young adults should focus on how they can provide support to individuals with mental health concerns and link them to resources

• Evaluation results indicate that young adults are relatively less stigmatizing & more likely to know those with mental health challenges, but unlikely to help link them to resources

Suggested Activities to Sustain:Stigma & Discrimination Reduction



• Training in Stigma Reduction Interventions– Suggest sustaining NAMI training, prioritizing those that focus

on reaching “influencers”• In Our Own Voice (IOOV) priority because evidence-based, and

can be targeted to different types of audience.• Important to develop and evaluate a culturally and linguistically

adapted training (similar to IOOV) appropriate for dissemination to Asian-American and Spanish speaking Californians

– Consider sustaining Mental Health First Aid (MHFA)• Evidence-based• Addresses support provision

• Training in Stigma Reduction Interventions– Suggest sustaining NAMI training, prioritizing those that focus

on reaching “influencers”• In Our Own Voice (IOOV) priority because evidence-based, and

can be targeted to different types of audience.• Important to develop and evaluate a culturally and linguistically

adapted training (similar to IOOV) appropriate for dissemination to Asian-American and Spanish speaking Californians

– Consider sustaining Mental Health First Aid (MHFA)• Evidence-based• Addresses support provision




• Social Marketing Campaign– Suggest continued dissemination of the “Know the Signs”

(KTS) suicide prevention campaign• Evaluation found that those who saw KTS materials were more

confident in intervening with those at risk of suicide• Expert panel convened by RAND concluded that KTS

messaging and marketing approach better than most.– Culturally and linguistically appropriate campaign

dissemination to Asian Americans and those who do not speak English

• Evaluation found exposure to KTS messages was lower among these groups

– Gaps in Suicide Prevention Campaign• Means restriction • Reaching the elderly, who are at higher risk

• Social Marketing Campaign– Suggest continued dissemination of the “Know the Signs”

(KTS) suicide prevention campaign• Evaluation found that those who saw KTS materials were more

confident in intervening with those at risk of suicide• Expert panel convened by RAND concluded that KTS

messaging and marketing approach better than most.– Culturally and linguistically appropriate campaign

dissemination to Asian Americans and those who do not speak English

• Evaluation found exposure to KTS messages was lower among these groups

– Gaps in Suicide Prevention Campaign• Means restriction • Reaching the elderly, who are at higher risk

Suggested Activities to Sustain:Suicide Prevention



• Training in Suicide Intervention Skills– Applied Suicide Intervention Skills Training (ASIST) should be

targeted to and tailored for vocations that are likely be in a position to provide help (e.g., police, school counselors).

– Suggest ongoing use of RAND’s fidelity and adherence protocol for improving trainer competencies.

– Recommend a new focus on training primary care providers and health care organizations in depression identification and integrated care delivery

• Training in Suicide Intervention Skills– Applied Suicide Intervention Skills Training (ASIST) should be

targeted to and tailored for vocations that are likely be in a position to provide help (e.g., police, school counselors).

– Suggest ongoing use of RAND’s fidelity and adherence protocol for improving trainer competencies.

– Recommend a new focus on training primary care providers and health care organizations in depression identification and integrated care delivery




• Hotlines/Warmlines Operated by Local Crisis Centers– Continue efforts to evaluate and improve the quality of

hotlines/warmlines, including regular reporting of common metrics on calls, acheiving accreditation, and monitoring quality of calls.

– Consider pros and cons of local model as compared to alternative call center models such as blended call centers (e.g., centers that also receive “211” calls) or a more centralized system.

• RAND is currently developing a policy paper to help frame these issues

• In-Person and Online Suicide Prevention Services– Recommend support of a diverse array of crisis services, ranging

from in-person to online, based on evaluation of resource preferences.

• Hotlines/Warmlines Operated by Local Crisis Centers– Continue efforts to evaluate and improve the quality of

hotlines/warmlines, including regular reporting of common metrics on calls, acheiving accreditation, and monitoring quality of calls.

– Consider pros and cons of local model as compared to alternative call center models such as blended call centers (e.g., centers that also receive “211” calls) or a more centralized system.

• RAND is currently developing a policy paper to help frame these issues

• In-Person and Online Suicide Prevention Services– Recommend support of a diverse array of crisis services, ranging

from in-person to online, based on evaluation of resource preferences.




• Training School Faculty/Staff/Students in Evidence-Based Interventions

– Invest in a sustainable training capacity (e.g., online learning) for the most useful or in-demand trainings

– Sustain trainings with a robust evidence base (e.g., ASIST, MHFA)

– Broaden visibility of trainings for staff/faculty and provide incentives for attendance.

• Evaluation found that <40% of faculty/staff believe they have the skills to help students with mental health problems, and the largest barrier to training participation was not knowing about trainings that were offered

• Training School Faculty/Staff/Students in Evidence-Based Interventions

– Invest in a sustainable training capacity (e.g., online learning) for the most useful or in-demand trainings

– Sustain trainings with a robust evidence base (e.g., ASIST, MHFA)

– Broaden visibility of trainings for staff/faculty and provide incentives for attendance.

• Evaluation found that <40% of faculty/staff believe they have the skills to help students with mental health problems, and the largest barrier to training participation was not knowing about trainings that were offered

Suggested Activities to Sustain:Student Mental Health



• Websites– Recommend efforts to sustain web-based resources, and

continued efforts to publicize them.• RAND evaluation suggests increasing use of websites, and

they are relatively inexpensive to maintain

• Collaboration/Networking– Some networks and collaborations among agencies and

organizations supporting SMH have had a large impact across institutions and communities and relatively cost-effective to sustain.

• School-Based Assessment– Higher ed climate survey can help inform future activities and to

monitor the status of student needs– UC online Interactive Screening Program (ISP) is helpful in

identifying student mental health needs

• Websites– Recommend efforts to sustain web-based resources, and

continued efforts to publicize them.• RAND evaluation suggests increasing use of websites, and

they are relatively inexpensive to maintain

• Collaboration/Networking– Some networks and collaborations among agencies and

organizations supporting SMH have had a large impact across institutions and communities and relatively cost-effective to sustain.

• School-Based Assessment– Higher ed climate survey can help inform future activities and to

monitor the status of student needs– UC online Interactive Screening Program (ISP) is helpful in

identifying student mental health needs




• Program-Level Evaluation

• Population Surveillance– Recommend efforts to coordinate with and improve existing

population surveillance systems so that they better support population tracking related to PEI efforts.

• Improve standards in California for investigating and reporting death by suicide (adopt national recommendations)

• Enhance the California Health Interview Survey (CHIS)• Enhance the K–12 California School Climate, Health, and

Learning Survey (CAL-SCHLS) by incorporating key items into core or commonly used modules

• Sustain higher education campus-wide surveys

• Targeted Effectiveness Studies

• Program-Level Evaluation

• Population Surveillance– Recommend efforts to coordinate with and improve existing

population surveillance systems so that they better support population tracking related to PEI efforts.

• Improve standards in California for investigating and reporting death by suicide (adopt national recommendations)

• Enhance the California Health Interview Survey (CHIS)• Enhance the K–12 California School Climate, Health, and

Learning Survey (CAL-SCHLS) by incorporating key items into core or commonly used modules

• Sustain higher education campus-wide surveys

• Targeted Effectiveness Studies

Suggested Activities to Sustain:Evaluation

Suggested Activities to Sustain:Evaluation


• These recommendations are informed by key RAND publications:

Interventions to Reduce Mental Health Stigma and Discrimination: A Literature Review to Guide Evaluation of California's Mental Health Prevention and Early Intervention Initiative

Interventions to Prevent Suicide: A Literature Review to Guide Evaluation of California's Mental Health Prevention and Early Intervention Initiative

Interventions to Improve Student Mental Health: A Literature Review to Guide Evaluation of California's Mental Health Prevention and Early Intervention Initiative

What Has the CalMHSA Statewide Mental Health Prevention and Early Intervention Program Done So Far? Key Results from the Baseline RAND General Population Survey

Adults Exposed to “Know the Signs” Are More Confident Intervening with Those At Risk for Suicide

Racial and Ethnic Differences in Mental Illness Stigma in California

Racial and Ethnic Differences in Exposure to Suicide Prevention Messaging, Confidence in One’s Ability to Intervene with Someone at Risk, and Resource Preferences,

CalMHSA Student Mental Health Campus-Wide Survey: 2013 Summary Report

• These publications and others are available at: http://www.rand.org/health/projects/calmhsa.html

• These recommendations are informed by key RAND publications:

Interventions to Reduce Mental Health Stigma and Discrimination: A Literature Review to Guide Evaluation of California's Mental Health Prevention and Early Intervention Initiative

Interventions to Prevent Suicide: A Literature Review to Guide Evaluation of California's Mental Health Prevention and Early Intervention Initiative

Interventions to Improve Student Mental Health: A Literature Review to Guide Evaluation of California's Mental Health Prevention and Early Intervention Initiative

What Has the CalMHSA Statewide Mental Health Prevention and Early Intervention Program Done So Far? Key Results from the Baseline RAND General Population Survey

Adults Exposed to “Know the Signs” Are More Confident Intervening with Those At Risk for Suicide

Racial and Ethnic Differences in Mental Illness Stigma in California

Racial and Ethnic Differences in Exposure to Suicide Prevention Messaging, Confidence in One’s Ability to Intervene with Someone at Risk, and Resource Preferences,

CalMHSA Student Mental Health Campus-Wide Survey: 2013 Summary Report

• These publications and others are available at: http://www.rand.org/health/projects/calmhsa.html

RAND PublicationsRAND Publications

http://www.rand.org/health/projects/calmhsa.html






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