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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