United Advocates for Children and Families Stigma and Discrimination Reduction: Strategies for a Supportive Environment: Capacity Building
Background United Advocates for Children and Families (UACF) received a contract from CalMHSA to reduce mental health stigma and discrimination by conducting a needs assessment, developing a strategic plan for stigma reduction (SDR), and implementing capacity building strategies and information dissemination approaches for stigma reduction. Our approach started and stayed within the community; allowing the community to identify gaps, assist in recognizing and utilizing existing and emerging community expertise, and supplanting that expertise with resources, training, and support that would build their capacity to respond, respect, and build indigenous culturally competent capacity relative to preventing and addressing mental health stigma and discrimination. The main focus of our activities relative to this contract included: Identifying the Issues: Expanding Collaborative Partnerships, Needs Assessment and Advisory Committee Fostering Community Partnerships for Change: Community Connections and Roundtables Grassroots Capacity Building: Training In addition, UACF worked closely with the social marketing component of the campaign to leverage strategies for greater media, public awareness, and family member participation in speaker s bureaus, local presentations and research.
I. Identifying the Issues Expanding Collaborative Partnerships Due to the cultural, geographic, and diversity factors across the state, we facilitated new partnerships that would allow us to be responsive to the populations and their unique characteristics across all components of the project. The subcontractors participating in the project planning process, development of best practices to identify and understand diverse population and community needs, and outreach to underrepresented groups and communities included Christian Partnerships Inc. (CPI), California Association of School Psychologists (CASP), California Youth Empowerment Network (CAYEN), and Racial and Ethnic Mental Health Disparities Coalition (REMHDCO). Each of these formal partners played a role in shaping the cultural, ethnic, linguistic, and spiritual competency of each stage of the project. Needs Assessment UACF developed a Capacity Building Needs Assessment or Gap Analysis Tool to inform and create the tasks and activities to be included in the project. The tool included a demographic and socioeconomic profile of each County in the 12 Regions and a vulnerability index to identify the underserved or underrepresented members of the county and region; highlighting targeted high risk populations identified through research of risk and vulnerability markers within subpopulations to ascertain the factors that may precipitate a higher than average propensity within targeted populations. In addition, UACF utilized focus groups in targeted, high risk regions, interviews with service providers and surveys to counties and community-based organizations to ensure we were understanding and responding to their unique needs around issues of mental health stigma and discrimination. Advisory Committee UACF formed a statewide Network Advisory Committee and coordinate with the Cal MHSA PEI Mental Health Initiative Statewide Coordination Workgroup to oversee all program elements. The Committee contributed its expertise, resources and local contacts to help guide the project and its activities. Representation included the UACF CEO, a Community Leader from each of UACF s 12 geographical family networks, Sub-contracted partners, Juvenile Justice System, CalMHSA, Chambers of Commerce, Mental Health Provider, Family Member/Parent Partner, Public Policy Facilitator, and a Veteran or family member of a Veteran. To ensure geographical representation, cultural and ethnic engagement, involvement of key targeted populations, and in-depth county participation and community penetration, the statewide Network Advisory Committee also provided oversight, planning, implementation, coordination and feedback (lessons learned) over the life of the project.
II. Fostering Community Partnerships for Change Community Connections A central focus of our Community Outreach SDR effort is to reach the grass roots level of the community, by engaging and contracting with local CBO s who are already serving populations identified by the planning group and the county. They have been essential to implement the provisions of the CalMHSA/UACF Community Outreach Plan developed by each county. Early on, we discovered that it was absolutely essential to begin the process of respecting and including counties in the project by meeting with each county mental health director to have a dialogue about the county s priorities for SDR outreach to their underserved populations. In each case, the county director assigned lead management staff to work with the UACF SDR team to accomplish the goals and objectives of this CalMHSA initiative. It should be noted here that all counties we engaged had SDR activities in place already and we essentially enhanced or expanded on existing efforts or focused our efforts on populations or geographic areas that were not being address adequately. In addition, meeting with the director gave us an opportunity to describe the scope and breadth of the SDR Community Outreach Project and expected outcomes. Planning for the sustainability of SDR activities was addressed from the very beginning by acknowledging the partnership between the County, stakeholder planning group (Roundtable), contracted CBO, UACF, and connection with other statewide CalMHSA initiatives. Involving the directors, CalMHSA Liaisons, CalMHSA Contract Specialists, County Regional WET Coordinators, provider organizations and community leaders has been essential to insure sustainability at the grassroots level. Roundtables To ensure a county and community driven approach, we established a stakeholder planning group (sometimes referred to as the Roundtable ) focused on SDR activities countywide and set the parameters and priorities of the SDR community outreach efforts. These groups were comprised of representatives relevant to that community, which may include: consumers and their families; advocates; and clinical, administrative, and outreach service providers for children and adults, UACF chapter affiliates, community-based organizations, LGBTQ, school psychologists, county officials, faith-based organizations, juvenile justice, foster care, cultural and ethnic groups, youth, veterans and their families and chambers of commerce The primary goal of these planning groups were to develop a SDR plan that incorporated existing efforts, provide an analysis of gaps and priorities for each county, and develop a sustainability plan.
III. Grassroots Capacity Building With an eye on grassroots capacity building that was population responsive, culturally competent, and sensitive to the nuances of the county we offered community based trainings through train-the-trainer certified curriculums that offered an opportunity for community leaders to become certified trainers on mental illness and mental wellness. To enhance the knowledge of mental illness and stigma reduction and discrimination our training focus included Tell Your Story T4T training and Mental Health First Aid trainings in addition to a Speakers Bureau for symposiums, conferences and workshops. The UACF T4T Telling Your Story: Storytelling Change Agents Training is a 2 day train-the-trainer training to empower consumers, families, and youth to tell their stories in a manner that impacts systems change, community response, and neutralizes the stigma and discrimination often associated with mental health challenges. The target audience includes consumers of mental health services, family members and youth with mental health challenges throughout the state. Tell Your Story participants build their capacity and gain tools and resources to assist them in telling their story in a format that is effective, comfortable, and capable of transformation and change within the public mental health system. In addition, faith leaders received a Mental Health Awareness training to better understand issues facing their communities regarding the delivery of Mental Health Services and foster collaboration between the Faith Communities, Government agencies and Mental Health Providers that will lead to creating mental health-friendly congregations. Finally, after a statewide assessment to research how to best meet the Mental Health First Aid training expansion needs of counties, leverage existing investments, fill in gaps with what is currently provided to support certified instructors and avoid duplication of efforts, UACF offered and coordinated MHFA 5-day Instructor trainings in targeted communities. The results of the statewide assessment were used to create opportunities for regional approaches to training events and included an expansion of 140-150 MHFA Certified Instructors, as well as adaptation training for Youth and Rural populations. UACF coordinated trainings with the 5-County Regional WET Coordinators and we created and maintain a database of key information about newly certified instructors.
Results of Our Efforts Many of the results of this project will never be measured because we believe that the impact and outcomes may not be seen as an immediate result of our efforts. The shifts we made as a result of what we did or learned could likely show up years from now. It is difficult to measure a change in actions that result from a shift in beliefs. But, we did capture some of the results of our efforts, showing the outreach, participation, and satisfaction below. Tell Your Story Tell Your Story curriculum has impacted 127 community members throughout the state. UACF has trained 47 Tell Your Story trainers in Los Angeles, San Diego, Humboldt and Fresno UACF has reached 80 participants for the Tell Your Story Community trainings Future Tell Your Story trainings will be held for Orange (June 16 th -17 th ), Ventura and Lassen/Modoc counties Community Events 96 participants for 10 Initial in-person meetings with Los Angeles, San Diego, San Bernardino, Santa Clara, Fresno and Ventura County Behavioral Health Directors and staff 731 total participants for 8 Community Events o Los Angeles, 3-Roundtable Events and Clergy Academy o San Diego, Roundtable Event o Santa Clara, All Community Mental Health Event (collaboration and keynote) o San Bernardino, Mental Health Symposium (collaboration and keynote) o San Francisco, Annual Advocacy and Collaboration Conference 2012 (keynote) Focus Groups Outreach and Participation Four subcontractors invited 154 individuals from diverse cultures, geographic locations, and socioeconomic backgrounds to 7 different Focus Group events. 55 individuals representing five languages attended and participate in the events. A majority of those participating (41) responded for themselves with the lesser number for their child, youth, a spouse or partner, a friend, or other. Most of them represented the 25-59 year old age group. The largest representative race and ethnicity was from the Latino/Hispanic/Chicano population (26).
Improving Mental Health Outcomes: Stigma and Discrimination Survey Distributed to 7507 contacts and have received 906 completed forms Participation from community members throughout the state Questions consisted of demographics and stigmatizing experiences due to mental health diagnosis UACF Developed Materials 25 materials developed for promotional and dissemination purposes including: o MHFA Training Reports o Community Network Roundtable Toolkit o 2012 Stigma and Discrimination Focus Group Report o SDR Brochure o SDR Capacity Building Train the Trainer Flyer o A newly enhanced and redesigned UACF website Mental Health First Aid Central County Region (18 Counties in that region): Received the 5-day Youth MHFA instructor curriculum training on January 13 17, 2014; resulting in 24 certified instructors (1 pending certification).results for all trainings will be 140 150 certified instructors 4 Instructor trainings remaining 32 slots each: o Monday, June 9, 2014 Friday, June 13, 2014; Adult Curriculum in San Leandro, CA: Bay Area County Region o Monday, July 28, 2014 Friday, August 1, 2014; Adult Curriculum in Redding, CA: Superior County Region o Monday, September 8, 2014 Friday, September 12, 2014; Adult Curriculum in Orange, CA: Southern County Region o Monday, October 20, 2014 Friday, October 24, 2014; Youth Curriculum in Los Angeles, CA: Los Angeles County Region Faith Based Community Trainings Expected mental health trainings for faith based communities in 10 Regions: Humboldt, Modoc/Lassen, Santa Clara, Merced, Fresno, Ventura, Los Angeles, Orange, San Bernardino, San Diego
Lessons Learned The lessons learned started the first day of the project and will likely continue for decades. By taking the time to identify high risk populations and areas, capture and analyze their impressions and experiences, partnering with grassroots leaders who work on the forefront of communities, and implementing trainings that can strengthen the voice of those with lived experience while expanding public capacity to identify and respond to mental health needs, we have captured some of the most critical lessons learned below. The interpretation of mental health, stigma, and discrimination experiences were often defined by age, culture, language, and geographic location. People had to be met where they are. Diverse populations had difficulty separating stigma and discrimination due to race, ethnicity, cultural, language, and sexual orientation and that caused by mental illness. Vulnerable populations tended to generalize stigma and discrimination, regardless of the potential cause. Each county and community within counties is unique; there is no template to successfully implement the program. Each area, neighborhood, community must be approached as a new entity, without assumptions are a premise of what will or will not work. The CBO s and County Directors are integral to the overall success and must be assertively engaged through every phase and activity. Specific strategies that respond to their unique and individual preferences must be utilized to ensure their ongoing involvement. Timelines must be flexible and respectful of county environments and population culture and needs to ensure positive outcomes. Trainings must be flexible enough to accommodate community and population nuances while balancing integrity and intended outcomes. As a new endeavor, it is critical to ensure that there is aggressive marketing to facilitate a practical and relevant understanding and common expectations of all phases and components. Data collection and submitting process must be more streamlined. UACF should have stayed with their original data collection and evaluation plan so that our project could have benefited from live data and evaluation. The collection of data and evaluation from CalMHSA was confusing and did not result in real time information for incremental adjustments, allowing missed opportunities and the gathering of data that was not helpful to the project from the UACF management point.
UACF s anti-stigma campaign, administered by CalMHSA, is funded by the voter approved Mental Health Services Act (Prop. 63). CalMHSA is an organization of county governments working to improve mental health outcomes for individuals, families and communities. CalMHSA operates services and education programs on a statewide, regional, and local basis. United Advocates for Children and Families 2035 Hurley Way, Suite 290 Sacramento, CA 95825 (916) 643-1530 info@uacf4hope.org www.uacf4hope.org