1 Prevention and Early Intervention (PEI) Guidelines Webcasts Building Partnerships: Strategies for Outreach and Engagement to Underserved Ethnic and Cultural

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Prevention and Early Intervention (PEI) Prevention and Early Intervention (PEI) Guidelines WebcastsGuidelines Webcasts

Building Partnerships: Building Partnerships: Strategies for Outreach and Engagement to Strategies for Outreach and Engagement to

Underserved Ethnic and Cultural Communities Underserved Ethnic and Cultural Communities in Your Countyin Your County

DMH/CRHD Interagency AgreementDMH/CRHD Interagency Agreement

Center for Reducing Health DisparitiesCenter for Reducing Health DisparitiesUC Davis School of MedicineUC Davis School of Medicine

November 2, 2007November 2, 2007

http://www.dmh.ca.gov/default.asp

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ContextContext

The MHSA calls for an expansion of mental The MHSA calls for an expansion of mental health services with a focus on underserved health services with a focus on underserved and unserved populationsand unserved populations

The PEI Guidelines have identified:The PEI Guidelines have identified: Disparities in access to mental health services as a Disparities in access to mental health services as a

key community needkey community need

Underserved and unserved communities as key Underserved and unserved communities as key populationspopulations

A Community Program Planning ProcessA Community Program Planning Process that that requires outreach and engagement to underserved requires outreach and engagement to underserved and unserved communitiesand unserved communities

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PEI GuidelinesPEI Guidelines

“Efforts should be made to include individuals from underserved racial/ethnic and cultural communities in the planning process.”

“Outreach efforts could include consultations with key informants, members and leaders of underserved communities with knowledge of mental health needs.”

“Input from key informants could be sought through focus groups and other appropriate methods regarding community perceptions of needs, priority populations, community assets relevant to PEI efforts, potential projects and evaluation methods.””

Source: http://www.dmh.ca.gov/DMHDocs/default.asp?view=notices, p. 14

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PEI GuidelinesPEI Guidelines

“These efforts might have as their goal the ongoing inclusion of community perspectives in PEI component implementation over the long term.”

“Informants representing underserved communities should be involved in the drafting of county components.”

“Successful outreach and engagement processes in the planning stage can be reflected in elements of the county components, demonstrating collaboration with community based organizations to address needs of underserved communities.””

Source: http://www.dmh.ca.gov/DMHDocs/default.asp?view=notices, p. 14

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““Go in search of people. Begin with Go in search of people. Begin with what they know. Build on what they know. Build on

what they have”what they have”

Chinese proverbChinese proverb

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Release of the UCD CRHD-DMH ReportRelease of the UCD CRHD-DMH Report

BUILDING PARTNERSHIPS:BUILDING PARTNERSHIPS:KEY CONSIDERATIONS WHEN ENGAGING KEY CONSIDERATIONS WHEN ENGAGING

UNDERSERVED COMMUNITIES UNDER THE MHSAUNDERSERVED COMMUNITIES UNDER THE MHSA

Purpose of the Report:Purpose of the Report:

Introduce guiding principles of community engagement Introduce guiding principles of community engagement with underserved communities;with underserved communities;

Outline some guiding questions to assist counties in Outline some guiding questions to assist counties in their MHSA community outreach and stakeholder their MHSA community outreach and stakeholder processes;processes;

Suggest specific strategies that Counties Mental Health Suggest specific strategies that Counties Mental Health departments might employ to nurture sustained and departments might employ to nurture sustained and equitable partnerships with communities.equitable partnerships with communities.

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CRHD Recommended StrategiesCRHD Recommended Strategies

1.1. Identifying underserved communities within your countyIdentifying underserved communities within your county

2.2. Establishing bi-directional relationshipsEstablishing bi-directional relationships Finding community representativesFinding community representatives

3.3. Facilitating meetings and exchanging informationFacilitating meetings and exchanging information Engaging community representatives and maximizing the Engaging community representatives and maximizing the

opportunity for trusting communicationopportunity for trusting communication

4.4. Using the information once it is collectedUsing the information once it is collected Making sure the voices are heard and integrated into PEI Making sure the voices are heard and integrated into PEI

programmatic plansprogrammatic plans

Building ongoing partnershipsBuilding ongoing partnerships

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Groups historically underserved by mental Groups historically underserved by mental health serviceshealth services

Groups facing geographic or linguistic Groups facing geographic or linguistic barriers to carebarriers to care

PEI priority populations PEI priority populations

Local priority populationsLocal priority populations

Groups with high uninsurance, Groups with high uninsurance, underinsurance and/or poverty ratesunderinsurance and/or poverty rates

1. Identifying Underserved 1. Identifying Underserved Communities Within your CountyCommunities Within your County

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1. Identifying Underserved Communities 1. Identifying Underserved Communities Within your County Within your County (cont’d)(cont’d)

Tap into data sources Tap into data sources Census dataCensus data Statewide and local reportsStatewide and local reports

California Health Interview Survey (CHIS)California Health Interview Survey (CHIS) Kaiser Family FoundationKaiser Family Foundation The California EndowmentThe California Endowment Public School data Public School data First 5 Children and Families Commission dataFirst 5 Children and Families Commission data

Trends of penetration ratesTrends of penetration rates Department of Public Health dataDepartment of Public Health data Data resources within communities such as United Way, Data resources within communities such as United Way,

NGOs, etc.NGOs, etc.

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2. Establishing Bi-directional 2. Establishing Bi-directional RelationshipsRelationships

Clarity of purposeClarity of purpose Understand that the relationship will be a two-way Understand that the relationship will be a two-way

relationshiprelationship

Awareness of past interactions with communityAwareness of past interactions with community

Recognize that part of the purpose is building up Recognize that part of the purpose is building up ongoing relationshipsongoing relationships

Be clear about how participants can influence the Be clear about how participants can influence the decisions that may be made and what issues cannot decisions that may be made and what issues cannot be influencedbe influenced

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2. Establishing Bi-directional 2. Establishing Bi-directional Relationships (cont’d)Relationships (cont’d)

Understanding the partner communityUnderstanding the partner community Be clear about who should be engagedBe clear about who should be engaged

Identify the community leaders and key community Identify the community leaders and key community organizations with whom to partner (who has trust, organizations with whom to partner (who has trust, respect, and credibility within the community?)respect, and credibility within the community?)

Address the “culture”, as well as the cultural, Address the “culture”, as well as the cultural, language, racial, and ethnic issues of the communitylanguage, racial, and ethnic issues of the community

Use awareness and sensitivity when working with Use awareness and sensitivity when working with tribal communities. Recognize and honor tribal tribal communities. Recognize and honor tribal sovereignty issuessovereignty issues

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Approach communities with awareness of past Approach communities with awareness of past interactions with community and be prepared to interactions with community and be prepared to address mistrust and disbeliefaddress mistrust and disbelief Be aware of how government agencies are perceivedBe aware of how government agencies are perceived

Validate concernsValidate concerns

Be transparent about your purpose and reasons for Be transparent about your purpose and reasons for being therebeing there

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Identify opportunities for co-learningIdentify opportunities for co-learning From the community to the countyFrom the community to the county: the communities’ : the communities’

needs, priorities, assets, existing resourcesneeds, priorities, assets, existing resources Existing services, programs that can be enhanced or Existing services, programs that can be enhanced or

supported by PEI initiative supported by PEI initiative

From the county to the communityFrom the county to the community: Informing : Informing opportunities for accessing funds and learn about opportunities for accessing funds and learn about procurement process and participation in policy procurement process and participation in policy decisionsdecisions

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3. Facilitating Meetings and 3. Facilitating Meetings and Exchange of InformationExchange of Information

In your initial communications with the In your initial communications with the community, be clear about your financial, community, be clear about your financial, time, personnel and other constraintstime, personnel and other constraints

Approach the community cultural brokers for Approach the community cultural brokers for advice onadvice on

Who to talk with (e.g., men and women separately?, Who to talk with (e.g., men and women separately?, immigrants by how long they have been here, by ethnic immigrants by how long they have been here, by ethnic subgroup)subgroup)

Where to hold meetings (e.g., schools, community Where to hold meetings (e.g., schools, community centers, migrant camps)centers, migrant camps)

When to hold meetings (e.g., evenings on weekdays, When to hold meetings (e.g., evenings on weekdays, weekday during the day, or weekend afternoons)weekday during the day, or weekend afternoons)

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3. Facilitating Meetings and 3. Facilitating Meetings and Exchanging Information (cont’d)Exchanging Information (cont’d)

Approach the community cultural brokers Approach the community cultural brokers for advice onfor advice on

Who should facilitate the meeting: Is ethnic, Who should facilitate the meeting: Is ethnic, cultural, and language matching important?cultural, and language matching important?

Should the facilitator be a member of the Should the facilitator be a member of the community or a county representative?community or a county representative?

How questions should be worded?How questions should be worded?

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Choice of methodology Choice of methodology Focus groups (8-10 people)Focus groups (8-10 people)

Community/town forums (e.g., 50+ people, Community/town forums (e.g., 50+ people, open to the public)open to the public)

Face-to-face interviews (with “key” community Face-to-face interviews (with “key” community members)members)

Surveys: face-to-face with interviewer or self-Surveys: face-to-face with interviewer or self-administered written surveyadministered written survey

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Tips on running focus groupsTips on running focus groups Facilitator should have a good Facilitator should have a good

understanding of PEI guidelines, the understanding of PEI guidelines, the purpose of community participation, and purpose of community participation, and know how to promote a safe and trusting know how to promote a safe and trusting environment for the discussionenvironment for the discussion

Consider employing health outreach workers already Consider employing health outreach workers already experienced with the community (e.g., promotores/as)experienced with the community (e.g., promotores/as)

Come in with broad themes and have the Come in with broad themes and have the flexibility to let the community set the flexibility to let the community set the direction of discussiondirection of discussion

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Tips on running focus groupsTips on running focus groups Determine most reliable way to capture the Determine most reliable way to capture the

information (e.g., multiple note takers, audio information (e.g., multiple note takers, audio recording, facilitator summarizing points on paper recording, facilitator summarizing points on paper visible to audience, use of LCD projector)visible to audience, use of LCD projector)

Immediately after the focus group is complete, Immediately after the focus group is complete, facilitator or other county participant should write a facilitator or other county participant should write a summary of the contentsummary of the content

If interpreters are to be used, allocate enough If interpreters are to be used, allocate enough resources to have experienced interpreters at handresources to have experienced interpreters at hand

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Tips on conducting surveysTips on conducting surveys Keep it simple; it is best if written surveys take no Keep it simple; it is best if written surveys take no

more than 15 minutes to completemore than 15 minutes to complete

Pre-test questions on a small number (e.g., 10) of Pre-test questions on a small number (e.g., 10) of people from the partner community; speak to people from the partner community; speak to them afterwards to get their feedback about the them afterwards to get their feedback about the questions (e.g., did they make sense?)questions (e.g., did they make sense?)

The best questions are ones that elicit a variety of The best questions are ones that elicit a variety of responses; but not too much varietyresponses; but not too much variety

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Translations and AdaptationsTranslations and Adaptations This should not be an afterthoughtThis should not be an afterthought Allocate enough resources and time for quality Allocate enough resources and time for quality

translations and adaptations of written materials; the translations and adaptations of written materials; the translations and adaptations must address both translations and adaptations must address both language and cultural contentlanguage and cultural content

Utilize assets within the partner community and/or Utilize assets within the partner community and/or public health/school-based organizationspublic health/school-based organizations

Review of materials should be done in collaboration with Review of materials should be done in collaboration with community cultural brokers and qualified bilingual community cultural brokers and qualified bilingual county staffcounty staff

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4. Using the Information Once 4. Using the Information Once it’s Availableit’s Available

Focus group, townhall/community meetings, one-Focus group, townhall/community meetings, one-on-one interviewson-one interviews

Issues to considerIssues to consider Transcription: Consider transcription of agreed upon Transcription: Consider transcription of agreed upon

key parts onlykey parts only One suggestion: Have facilitator write summary of One suggestion: Have facilitator write summary of

content and two others independently review content and two others independently review audio/transcription and independently write summariesaudio/transcription and independently write summaries

Compare the summaries, resolve differences, and Compare the summaries, resolve differences, and merge into a single summarymerge into a single summary

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4. Using the Information Once it’s 4. Using the Information Once it’s Available (cont’d)Available (cont’d)

Making sure the voices are heard and Making sure the voices are heard and integrated into plans integrated into plans

Translating community input into the PEI Translating community input into the PEI plan for countiesplan for counties

Community program planning processCommunity program planning process

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Suggestions Emerging for MHSA PEI Suggestions Emerging for MHSA PEI Planning ProcessPlanning Process

Engage underserved communities in places that matter to them (e.g., ESL classes, housing assistance, social service agencies);

Consider the role of paraprofessionals; Integrate mental health outreach and

treatment with other health and social services.

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Strengthening Counties’ Community Strengthening Counties’ Community Input Process Input Process

Limited time or capacity to address all the communities in the state that have specific needs. How can counties make community outreach and

engagement an integral part of ongoing policy processes?

Outreach takes time and long-term investment in communication and building trust. How can counties maintain ongoing relationships of

trust with underserved communities over time?

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Selected SourcesSelected Sources US Census Bureau:US Census Bureau:

American Community Survey: Data Profiles 2003 for CaliforniaAmerican Community Survey: Data Profiles 2003 for California http://www.census.gov/acs/www/Products/Profiles/Single/2003/ACS/CA.htmhttp://www.census.gov/acs/www/Products/Profiles/Single/2003/ACS/CA.htm

Centers for Disease Control and Prevention:Centers for Disease Control and Prevention: Principles of Community Engagement: Principles of Community Engagement: http://www.cdc.gov/phppo/pce/http://www.cdc.gov/phppo/pce/

The Kaiser Family Foundation:The Kaiser Family Foundation: The Uninsured and their Access to Health care:The Uninsured and their Access to Health care:

http://www.kff.org/uninsured/upload/1420_09.pdfhttp://www.kff.org/uninsured/upload/1420_09.pdf

The California Endowment:The California Endowment: Health Coverage Expansion in California: What Can Consumers Afford to Health Coverage Expansion in California: What Can Consumers Afford to

Spend?Spend?:: http://www.calendow.org/uploadedFiles/Health_Expansion_PB_091807(1).pdfhttp://www.calendow.org/uploadedFiles/Health_Expansion_PB_091807(1).pdf

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Selected Sources (cont’d)Selected Sources (cont’d) Institute of Medicine of the National Academies:Institute of Medicine of the National Academies:

Reports on Uninsurance: Reports on Uninsurance: http://www.iom.edu/CMS/3809/4660/4662.aspxhttp://www.iom.edu/CMS/3809/4660/4662.aspx Coverage Matters: Insurance and Health Care: Coverage Matters: Insurance and Health Care:

http://www.nap.edu/catalog.php?record_id=10188http://www.nap.edu/catalog.php?record_id=10188

United Way:United Way: Racial and Ethnic Health Disparities: A Review of Selected State Programs: Racial and Ethnic Health Disparities: A Review of Selected State Programs:

http://www.library.ca.gov/crb/06/02/06-002.pdfhttp://www.library.ca.gov/crb/06/02/06-002.pdf

California Health Interview Survey: California Health Interview Survey: http://www.chis.ucla.eduhttp://www.chis.ucla.edu UCLA Center for Policy Research:UCLA Center for Policy Research:

Health Insurance Coverage and Programs: Health Insurance Coverage and Programs: http://www.healthpolicy.ucla.edu/pubs/pubList.asp?topicID=5http://www.healthpolicy.ucla.edu/pubs/pubList.asp?topicID=5

Barriers to Disparities in Health Care: Barriers to Disparities in Health Care: http://www.healthpolicy.ucla.edu/pubs/pubList.asp?topicID=1&subTopicID=1http://www.healthpolicy.ucla.edu/pubs/pubList.asp?topicID=1&subTopicID=1

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Selected SourcesSelected Sources

First 5 California – have done asset mappingFirst 5 California – have done asset mapping http://www.ccfc.ca.gov/http://www.ccfc.ca.gov/

Department of Social Services – information on foster care Department of Social Services – information on foster care servicesservices http://www.cdss.ca.gov/ihss/http://www.cdss.ca.gov/ihss/

Department of Health Care Services – information on refugeesDepartment of Health Care Services – information on refugees http://www.dhcs.ca.gov/Pages/default.aspxhttp://www.dhcs.ca.gov/Pages/default.aspx

Juvenile JusticeJuvenile Justice Law EnforcementLaw Enforcement Alcohol and Drug Programs:Alcohol and Drug Programs:

http://www.adp.cahwnet.gov/http://www.adp.cahwnet.gov/

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AcknowledgementsAcknowledgements

UCD CRHDUCD CRHDSergio Aguilar-Gaxiola

Joshua Breslau

Leticia Carrillo

Natalia Debb-Sossa

Katherine Elliott

Ron King

Cristina Magaña

Arnulfo Medina

Elizabeth Miller

Marbella Sala

Bill Sribney

DMH/MHSOACDMH/MHSOACEmily Nahat

Jennifer Clancy

Nichole Davis

Rachel Guerrero

Barbara Marquez

Sonia Mays

Sheri Whitt

Beverly Whitcomb

Lois Williams

CMHDACMHDAAlfredo Aguirre

Bill Arroyo

Nancy Peña

Dan Souza

Stephanie Welch

Documents

1 Prevention and Early Intervention (PEI) Guidelines Webcasts Building Partnerships: Strategies for Outreach and Engagement to Underserved Ethnic and Cultural