1. Amanda Barczyk, M.S.W. 1 & Valarie Garza 2 The University of Texas at Austin School of Social Work 1 Texas Health Institute 2

2. Overview I. Transformation in America I. New Freedom Initiative II. New Freedom Commission III. Role of Substance Abuse and Mental Health Services Administration II. Transformation in Texas I. Transformation Workgroup II. Selected Communities III. Stigma Reducing Interventions I. Strategies II. Effective Components IV. Methods V. Stigma Experienced By Consumer VI. Implemented Stigma Reducing Strategies VII. Effectiveness of Stigma Reducing Strategies

3. Transformation in America New Freedom Initiative President Bush announces Initiative in February, 2001 Aims to… Increase access to assistive technologies Expand educational opportunities Increase ability for Americans with disabilities to integrate into workforce Increase access into daily community living

4. Transformation in America New Freedom Commission This key component was announced in April 29, 2002 First in 25 years Five Principle Goals Focus on desired outcomes Community-level models Policies that maximize the utility of existing resources by increasing cost-effectiveness and reducing unnecessary and burdensome regulatory barriers Use mental health research findings Follow principles of Federalism

5. Transformation in America New Freedom Commission Cont. Subcommittees developed Focused on smaller more specific areas Necessary to transform mental health system The goal of transformation is to restructure State systems to better meet the needs of individuals with or at risk of mental health problems and their families. Benchmarks/goals were set to track their effort

6. Transformation in America Role of Substance Abuse & Mental Health Services Administration The Federal Action Agenda: First Steps Gave background of New Freedom Initiative Focused on five principles developed by Commission Created initial action steps Mental Health Transformation State Incentive Grants September, 2005, SAMHSA awarded $92.5 million to seven states over five year period Consumers and family members must be involved Required to provide a continuum of services including promotion, prevention, treatment, and recovery September, 2006 $21.9 million given to two more states over a five year period

7. Transformation in Texas Transformation Workgroup TWG developed to facilitate transformation Consists of 15 agencies/organizations Smaller workgroups developed specializing in… Consumer voice Adults Children and adolescents Housing Workforce development Data/IT

8. Transformation in Texas Selected Communities TWG put out RFP aiming for diverse communities Eight communities selected Urban Bexar County Safety Net Community Collaboration Williamson County Mental Health Task Force Dallas County Unified Public Mental Health Initiative Tarrant Transformation Project Rural West Texas Community Coalition Nacogdoches County Mental Health Collaborative Costal Bend Rural Health Partnership Border Terrell County Behavioral Health Collaborative

9. Stigma Reducing Interventions Strategies Protest Challenges inaccurate depictions of individuals with mental health problems by insisting on the cessation of negative stereotypes or negative images of individuals with mental health problems Education Promotes positive attitudes through the provision of information so that people are able to develop informed attitudes and beliefs about individuals with mental health problems. Contact Entails an individual with a mental health problem having a face- to-face encounter with others and sharing the personal experiences of working and living in the community with a mental health problem Combination

10. Stigma Reducing Interventions Effective Components Patient-centered Empower individuals to assist in development and implementation Target-specific Campaign targeting a group with power and discriminatory behaviors of that group

11. Study Aim Explore the stigma experienced by communities in Texas, assess whether the stigma-reduction campaigns developed are target specific and/or use a patient- centered approach and assess the preliminary effectiveness of the campaigns

12. Methods Two phase content analysis Phase I Interviews with representatives from seven communities Write-ups assessed for themes Phase II Roundtable discussions at Mental Health Transformation Focused Forum Write-ups assessed for stigma reducing strategies and effectiveness

13. Stigma Experienced by Consumers Phase I Three themes of stigma experienced Individual level Family level Community level Community level most predominant Law enforcement Providers School-based stigma

14. Implemented Stigma Reducing Strategies Phase II Campaigns utilized different strategies Target-specific Combined education and contact Focus on mental health not mental illness Consumer participation Only a small proportion showed an observed positive impact on reducing stigma

15. Conclusions Research shows effective strategies, however… Stigma reducing strategies in Texas are not all effective More implementation is needed in Texas in diverse areas Guidelines for implementation needed Pre-evaluation work with consumers Implementation and evaluation standards needed

16. Questions?