2. Campaign Steering Committee Friday, September 28 9-3 pm Roseville

3. 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

4. . VOICE

5. Public Comment Comments Welcome 3-minutes per comment

6. Update on Community Services and Supports Funds AB2034 One-time monies Impact to your recommendation

7. Crisis Triage Steering Committee Transition Age Youth AdultOlder Adult Lake Tahoe Children System Change Co-occurring/ Cultural Comp. SED,SMI Children, Youth & Adults, O.Adults Latino, TAY, Native American Voice MH & SMART Board Voice/ Direction System Transformation Full-service Partnerships YouthConsumerFamily Recommendation #1 Contingency Plan (no AB2034) Homeless 10% - $88k 90% - $793k 100% - $880k 0% - $0

8. Crisis Triage Steering Committee Transition Age Youth AdultOlder AdultLake TahoeChildren System Change Co-occurring/ Cultural Comp. Children, Youth & Adults, O.Adults Latino, TAY, Native American Voice MH & SMART Board Voice/ Direction System Transformation Full-service Partnerships YouthConsumerFamily Recommendation #2: Sent to State As Is 15% - $132k 10% - $88k60% - $529k Severely Emotionally Disturbed Severely Mentally Ill Lake Tahoe

9. Community Service & Supports Planning processes underway Early Intervention & Prevention No guidelines yet Limited Information Phase 1 $2.2M for 3 years New money: + $881K Technology Workforce Development Housing Innovative Programs MHSA Funding Plans (6) Facilities & Infrastructure

10. Prevention and Early Intervention Where we are in the planning process Review State Guidelines California Institute for Mental Health training

11. Review: PEI Planning Process Submit Plan Steering 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

12. California Institute of Mental Health Prevention and Early Intervention: A Framework for Decision-Making Lynne Marsenich, LCSW Senior Associate

13. Prevention & Intervention Dollars Guidelines 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 Strategies Disparity in access to mental health services Psycho-social impact of trauma At-risk children, youth, young adults Stigma discrimination Suicide risk

14. Prevention & Intervention Dollars Guidelines Long-Term Outcomes Reduce: School failure Homelessness Long-term suffering Unemployment Incarceration Removal from home (children) Suicide Partners: Collaboration & community partnerships Schools Primary care Faith-based Healers Early childhood ed. Youth-at-risk programs

15. Prevention & Intervention Dollars Guidelines Statewide Support Suicide prevention Anti-stigma Project training, tech. assistance, capacity building Ethnically & culturally specific programs & interventions Short-term goals, Evaluation, Accountability Plan must provide short-term goals with accountability measures 5-8% of County PEI funds must be spent on evaluation Out of MHSA Admin budget (not PEI)

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. Individual Biological and psychological dispositions Attitudes Values Knowledge Skills Problem behaviors such as truancy or criminal behavior or alcohol abuse

23. Peer Norms Activities Bonding Social Support Psychological Safety

24. Family Parenting disciplinary practices Emotional climate Family living situation Mutually reinforcing relationships

25. School/Workplace School –Bonding –Climate –Policy –Performance Workplace –Stress –Alienation from work –Climate –Organizational culture

26. Community Bonding Norms Resources Awareness/mobilization

27. Society Norms Policies Health promotion activities

28. 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

29. 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

30. 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

31. 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

32. 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

33. Suicide Target Population (s) –Elderly –Girls and young women –Gay and Lesbian youth –Adults with serious mental disorders –Native American youth

34. 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

35. Suicide Locus of intervention –Primary care clinic –School –Emergency room –Boys and Girls clubs, YWCA, YMCA –Faith based activity and or social clubs

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. Questions?

43. Group Planning ID Community Needs for Prevention & Early Intervention

44. Prioritization Process Steering Community (Tahoe) Community (Roseville) Community (Lincoln) ID Needs Prioritize (5) Steering Prioritize needs (3) Asset MappingCommunity Program Priorities Strategies Approval

45. Breakout Session Today Overview 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

46. Close Thank you Next meeting: Nov 30th Notes will be posted on web Meeting evaluation: thank you