Mental Health Services Act Prevention and Early ...wp.sbcounty.gov/dbh/wp-content/uploads/2016/06/PEI_CPAC_Outcomes...Behavioral Health Prevention and Early Intervention Mental Health

Behavioral HealthPrevention and Early Intervention

Mental Health Services Act

Prevention and Early

Intervention Component

www.SBCounty.gov

Erica Porteous

Acting Program Manager

November 20, 2014

Purpose of MHSA PEI


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Section I

Purpose of Mental Health Services Act (MHSA)

Prevention and Early Intervention (PEI) Component

Purpose of MHSA PEI


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WIC § 5840 (a)(b) states that counties shall design

programs that prevent mental illnesses from becoming

severe and disabling; emphasizing improvement on timely

access to services for underserved populations, including

the following components:

• Outreach to recognize the early signs of a mental

illness

• Access and linkage to services

• Reduction in stigma associated with mental illness or

seeking services

• Reduction in discrimination against those with a mental

illness

Purpose of MHSA PEI, cont’d


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Priority Populations include:

• Underserved Cultural Populations

• Individuals Experiencing Onset of Serious Psychiatric

Illness

• Children/Youth in Stressed Families

• Trauma-Exposed

• Children/Youth at Risk for School Failure

• Children and Youth at Risk of Juvenile Justice

Involvement

Prevention and Early Intervention Framework


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Source: Adapted from Mrazek and Haggerty (1994) and Commonwealth of Australia (2000)

No

known risk

Risk present

Early signs

Relapse

prevention

New PEI

Regulations

Expand EI

Prevention and Early Intervention Framework,

cont’d.


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Increase PROTECTIVE FACTORS

Reduce

RISK FACTORS

See Risk/Protective Factors for Mental Emotional and Behavioral Disorders

Across the Life Cycle handout

PEI Program Access Points


www.SBCounty.gov

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Community Based

System EnhancementSchool Based

Summary of PEI Programs


www.SBCounty.gov

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School

Based

Programs

School Based Community Based System Enhancement

1. Preschool PEI Program 1. Family Resource Center 1. Child and Youth Connection

2. Resilience Promotion in

African American Children

3. Native American Resource

Center

2. Coalition Against Sexual

Exploitation

3. Student Assistance

Program

2. NCTI Crossroads Education 3. Community Wholeness and

Enrichment

4. Promotores de Salud/

Community Health Workers

4. LIFT Program

5. Military Services and Family

Support

6. Older Adult Community

Services Program

PEI Program Services


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School

Based

Programs

FY 2013/14

75% (127,448)

20% (34,148)

5% (7,605)

Universal

Selective

Early Intervention

Unduplicated Individuals

Served169,201 total

individuals served

PEI Program Services, cont’d.


www.SBCounty.gov

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School

Based

Programs

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

FY 2011/12 FY 2012/13 FY 2013/14

89,846 85,229

169,201

231,287 231,964

369,713

Unduplicated

Duplicated

Services Provided

FY 2011/12-FY 2013/14

19% Average Increase

in Unduplicated

Services


in Duplicated

Services

Group Discussion


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School

Based

Programs

Section I

On your worksheet, please rate how well you

believe DBH has done in meeting the intent of the

MHSA PEI Component.

MHSA PEI Goals


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1. Reduce School Failure

2. Reduce Incarcerations/Juvenile Justice Involvement

3. Reduce Minor Consumers Removed from Home

4. Reduce Stigma and Discrimination

5. Reduce Prolonged Suffering

6. Reduce Suicide

7. Reduce Unemployment Among Consumers

8. Reduce Homelessness Among Consumers

All Goals Address Areas as they Relate to

Behavioral Health Concerns


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Section II Reduce School Failure/Dropout Rates

Reduce Incarcerations/Juvenile Justice Involvement

Reduce Minors Removed from their Home

Goal: Reduce School Failure Related to Behavioral Health


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PEI Strategies that

Reduce Risk Factors for School Failure

Risk Factor Strategy

Early aggressive behavior • Behavioral change skills building

• Parental and teacher support/education/training

Early persistent behavior problems

Symptoms of a variety of disorders

(e.g., ADHD, depression, anxiety)

• School-based interventions and treatment

• Individual and group counseling

• Educational outreach and engagement

• Community provider-school partnerships

Social deficiencies, hostile toward

peers, socially inhibited

• Bereavement and loss support

• Conflict resolution training

• Pro-social behavior education

Anti-social behavior, delinquency • Increased family involvement and bonding

• Culturally-specific activities and support

• Decision making education on how attitude/behavior

translates to positive life outcomes

Favorable attitudes towards drugs

Early substance use

• Education, skills and resources to help develop and

maintain a healthy life style

Goal: Reduce School Failure Related to Behavioral Health,

cont’d.


www.SBCounty.gov

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Preschool Students Integrating

Positive Behaviors

FY 2011/12 & FY 2013/14

8% Average

Improvement in All

Areas

0%

2%

4%

6%

8%

10%

12%

4%

5%

8%

10%

11%

12%

Average Improvement in IntegratingBehaviors

Goal: Reduce Incarcerations Related to Behavioral Health


www.SBCounty.gov

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PEI Strategies that

Reduce Risk Factors for Incarcerations

Risk Factor Strategy

Parental alcohol/drug use • Parental substance use/abuse screenings, support and

linkage

Cold/unresponsive mother behavior • Maternal attachment screening and support

• Family support and counseling

Poor impulse control, sensation

seeking

• Behavioral change skills building

• Parental and teacher support/education/training

Early persistent behavioral problems • Conflict resolution training

• Pro-social behavior education

Early substance use • Substance use screenings, support and linkage

School failure • Family support and participation

• Training and education in school environment

Lack of commitment to conventional

adult rules

• Integrated learning on attitudes/behaviors as they relate to

decision making and positive outcomes

Goal: Reduce Incarcerations Related to Behavioral Health,

cont’d.


www.SBCounty.gov

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Children/Youth Skills-Knowledge

FY 2011/12 - FY 2013/14

50% Average

Improvement Across

All Areas

0%

10%

20%

30%

40%

50%

60%

70%

27%

39%

65%

50%

66%

56%

% Improvement in Test Scores


www.SBCounty.gov

Page 18Goal: Reduce Removal of Minor from their Home

Risk Factors that Increase Likelihood of Removal from Home

-Lack of parental knowledge

-Aggressive behavior

-Safety risk for family and/or child/youth

Goal: Reduce Removal of Minor from their Home,

cont’d


www.SBCounty.gov

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Improvement in Child/Youth Familial Functioning

FY 2011/12 - FY 2013/14

43% Average

Improvement in

Test Scores

0%10%

20%30%

40%50%

% Improvement

38%

47%

Behavior Towards Others

Following Rules at Home

Group Discussion


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School

Based

Programs

Section II

Based on the data presented concerning reducing

school failure, reducing incarcerations and

reducing minors removed from their home, please

discuss:

• Strengths illustrated in meeting the goals

• Opportunities to strengthen how the department

meets/measures the goals

Group Discussion


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Section III Reduce Stigma and Discrimination Associated

with Mental Illness

Reduce Prolonged Suffering

Reduce Suicide

Goal: Reduce Stigma and Discrimination


www.SBCounty.gov

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8.50%6.30%

0.40%

49.60%

32.90%

2.30%

San Bernardino County Demographics

African American

Asian/Pacific Islander

Native American

Latino

Caucasion

Other

Source: California Dept. of Finance, 2012

PEI FY 2013/14

Demographics

11%

3%

1%

36%37%

12%

Goal: Reduce Stigma and Discrimination, cont’d


www.SBCounty.gov

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Mental Health: Help Seeking Assessment

FY 2012/13 – FY 2013/14

82% Average “YES”

Responses

0% 20% 40% 60% 80% 100%

I know who to go to for help if I need it.

I will ask for help when I need it.

86%

96%

76%

65%

83%

81%

Adult Survey

Youth Survey

Child Survey



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Mental Health Knowledge

Intent to Seek Services

Program Survey Question Indicator Results

Promotores de Salud/Community

Health Workers

Improved knowledge on mental illness. 68%


Health Workers

Improved knowledge on mental wellness. 68%

Native American Resource

Center

Aware of services available in the community. 60%

Program Survey Question Indicator Results


Health Workers

Intend to utilize mental health services. 64%


Health Workers

Confident in accessing mental health services. 61%

Native American Resource

Center

Willingness to participate in services. 70%

FY 2013/14

Post Survey Results



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Statewide Projects

• Foto Novelas/short

stories to educate/

engage families

• Directing Change film

contest for high school

students

• Walk In Our Shoes

campaign for children

grades 4th-6th

• The Speak Our Minds

speaker’s bureau project

to promote awareness

Goal: Reduce Prolonged Suffering


www.SBCounty.gov

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Improved Life Satisfaction

Increased Hope

Increased Resiliency

Decreased

Impairment in

Life Functioning

Outcomes for

Reduction of Prolonged

Suffering

Goal: Reduce Prolonged Suffering, cont’d.


www.SBCounty.gov

Page 27

PEI Global Assessment of Functioning

Average Pre-Post

FY 2011/12-FY 2013/14


0

10

20

30

40

50

60

70

FY 2011/12 FY 2012/13 FY 2013/14

60.4

54.9858.61

69.35

64.0562.42

Pre Score

Post Score

Goal: Reduce Prolonged Suffering, cont’d.


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Outcomes for Symptom Reduction

FY 2013/14

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Pre

Post


Goal: Reduce Suicide


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High Risk Population Strategy

Individuals living with a mental illness

and/or substance use disorder

• Multiple access points for early interventions and treatment

• Individual and group counseling

• Access and linkage to additional system of care resources

Individuals bereaved by suicide • Bereavement support groups and counseling

Individuals in justice or child welfare

settings

• Partnerships and collaboration with justice and child welfare systems to

address appropriate needs

American Indians/Alaska Natives • Culturally-specific programs for America Indians/Alaksa Natives

Individuals who identify lesbian, gay,

bisexual, transgender or questioning

(LGBTQ)

• LGBTQ-specific programs that emphasize outreach and delivery of

available resources in welcoming settings

Members of the Armed Forces and

veterans

• Military-specific programs that emphasize addressing unique needs of

military personnel and veterans and their families

Older men • Older adult-specific programs that emphasize outreach, engagement

and early interventions

All populations • ASSIST Training and safeTALK

PEI Strategies for High Risk Population

Goal: Reduce Suicide, cont’d.


www.SBCounty.gov

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PEI Statewide Projects

• Know The Signs

Campaign to educate on

warning signs and how to

help

• ASIST training for suicide

intervention

• safeTALK to become

suicide alert

• National Suicide

Prevention Lifeline to

take calls of those in crisis

Goal: Reduce Suicide, cont’d.


www.SBCounty.gov

Page 31

0

100

200

300

400

500

600

700

800

900

Number of Calls

Suicide Prevention Hotline Figures

for San Bernardino County

FY 2013/14

6,857 total calls

571 per month average

Group Discussion


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School

Based

Programs

Section III


stigma and discrimination associated with mental

illness, reducing prolonged suffering, reducing

suicide, please discuss:




Group Discussion


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Section IV Reduce Homelessness

Reduce Unemployment

Goal: Reduce Homelessness


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-Poor family functioning

-Socioeconomic disadvantage

-Less parental education

-Alcoholism in the family

-Abuse in the family

Risk Factors that Increase Likelihood of Homelessness

Goal: Reduce Homelessness, cont’d.


www.SBCounty.gov

Page 35

PEI Programs That Reduce Risk Factors for Homelessness

Program Risk Factor Strategy

Family Resource Center Socioeconomic disadvantage Employment assistance, computer literacy

training, ESL, access to resources, etc.

Military Services and

Family Supports

Poor family functioning Family-focused counseling and support

NCTI Crossroads Abuse in the family Parenting component, anger

management, life skills, communication

strategies

Native American

Resource Center

Alcoholism in the family White Bison 12 Step Program

LIFT Program Less parental education Case management, education and

support

Goal: Reduce Homelessness, cont’d.


www.SBCounty.gov

Page 36

Positive Parenting Test Scores

FY 2013/14

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Nurturing Parenting Education

60.0%

96.5%

Pre Score

Post Score

23.5% Average

Improvement in

Scores

Key Topics:

• Alternatives to Spanking

• Building Self-Worth in Children

• Positive Ways to Deal with Stress & Anger

• Family Morals, Values & Rules

• Positive Brain Development in Children

Goal: Reduce Unemployment


www.SBCounty.gov

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Employment Readiness Skills

FY 2013/14

Employment:

24% Average

Increase

Education:

8% Average

Increase

0

0.5

1

1.5

2

2.5

Employment Education

1.91

1.315

2.355

1.415

Pre

Post

Pre – “occasional/seasonal

or multiple entry-level jobs”

Post – “stable employment

in low income job”

Pre – “less than 12th grad

graduation”

Post – “graduation with a

GED or HSD”

Group Discussion


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Page 38

School

Based

Programs

Section IV


unemployment and reducing homelessness,

please discuss:




References


www.SBCounty.gov

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School

Based

Programs

County of San Bernardino Department of Behavioral Health MHSA Plans

http://www.sbcounty.gov/dbh/mhsa/mhsa.asp#

Journal of Abnormal Child Psychology. Trajectories of Peer-Nominated Aggression: Risk Status, Predictors and Outcomes, 2005.

http://dspace.ubvu.vu.nl/bitstream/handle/1871/16564/Lier_Journal%20of%20Abnormal%20Child%20Psychology_33(1)_2005_u.pdf

?sequence=2

Justice Center – The Council of State Governments. Serious Mental Illness and Arrest: The Generalized Mediating Effect of

Substance Use, 2007. http://csgjusticecenter.org/jc/publications/serious-mental-illness-and-arrest-the-generalized-mediating-effect-

of-substance-use/

Mental Health Services Act http://www.mhsoac.ca.gov/docs/MHSA_AsAmendedIn2012_AB1467AndOthers_010813.pdf

National Institutes of Health. Risk Factors for Homelessness: A Study of Families of Origin, 1995.

http://www.ncbi.nlm.nih.gov/pubmed/8829984

Prevention Institute. Connecting the Dots: An Overview of Among the Links of Multiple Forms of Violence, 2014.

http://preventioninstitute.org/component/jlibrary/article/id-356/127.html

Substance Abuse and Mental Health Services Administration. National Strategy for Suicide Prevention: How You Can Play a Role

in Preventing Suicide, 2012. http://www.surgeongeneral.gov/library/reports/national-strategy-suicide-prevention/factsheet.pdf

Substance Abuse and Mental Health Services Administration. A Behavioral Lens for Prevention, 2012.

http://captus.samhsa.gov/sites/default/files/capt_resource/capt_behavioral_health_fact_sheets_2012_0.pdf

U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention. Risk Factors for Delinquency: An Overview,

2003. https://www.ncjrs.gov/pdffiles1/ojjdp/frd030127.pdf

http://www.sbcounty.gov/dbh/mhsa/mhsa.asp

http://dspace.ubvu.vu.nl/bitstream/handle/1871/16564/Lier_Journal of Abnormal Child Psychology_33(1)_2005_u.pdf?sequence=2

http://csgjusticecenter.org/jc/publications/serious-mental-illness-and-arrest-the-generalized-mediating-effect-of-substance-use/

http://www.mhsoac.ca.gov/docs/MHSA_AsAmendedIn2012_AB1467AndOthers_010813.pdf

http://www.ncbi.nlm.nih.gov/pubmed/8829984

http://preventioninstitute.org/component/jlibrary/article/id-356/127.html

http://www.surgeongeneral.gov/library/reports/national-strategy-suicide-prevention/factsheet.pdf

http://captus.samhsa.gov/sites/default/files/capt_resource/capt_behavioral_health_fact_sheets_2012_0.pdf

https://www.ncjrs.gov/pdffiles1/ojjdp/frd030127.pdf

Closing


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School

Based

Programs

Thank you for your participation and thoughtful

feedback!

December CPAC will focus on Workforce Education

and Training Outcomes

Your continued feedback is valuable to us!

Please ensure we have collected each of the

surveys you completed today.

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