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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
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 2
Section I
Purpose of Mental Health Services Act (MHSA)
Prevention and Early Intervention (PEI) Component
Purpose of MHSA PEI
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 3
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
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 4
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
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 5
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.
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 6
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
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 7
Community Based
System EnhancementSchool Based
Summary of PEI Programs
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 8
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
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 9
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.
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 10
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
22% Average Increase
in Duplicated
Services
Group Discussion
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 11
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
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 12
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
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 13
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
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 14
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.
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 15
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
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 16
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.
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 17
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
Behavioral HealthPrevention and Early Intervention
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
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 19
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
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 20
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
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 21
Section III Reduce Stigma and Discrimination Associated
with Mental Illness
Reduce Prolonged Suffering
Reduce Suicide
Goal: Reduce Stigma and Discrimination
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 22
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
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 23
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
Goal: Reduce Stigma and Discrimination, cont’d
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 24
Mental Health Knowledge
Intent to Seek Services
Program Survey Question Indicator Results
Promotores de Salud/Community
Health Workers
Improved knowledge on mental illness. 68%
Promotores de Salud/Community
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
Promotores de Salud/Community
Health Workers
Intend to utilize mental health services. 64%
Promotores de Salud/Community
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
Goal: Reduce Stigma and Discrimination, cont’d
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 25
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
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 26
Improved Life Satisfaction
Increased Hope
Increased Resiliency
Decreased
Impairment in
Life Functioning
Outcomes for
Reduction of Prolonged
Suffering
Goal: Reduce Prolonged Suffering, cont’d.
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 27
PEI Global Assessment of Functioning
Average Pre-Post
FY 2011/12-FY 2013/14
13% Average Increase
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.
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 28
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
43% Average Increase
Goal: Reduce Suicide
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 29
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.
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 30
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.
Behavioral HealthPrevention and Early Intervention
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
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 32
School
Based
Programs
Section III
Based on the data presented concerning reducing
stigma and discrimination associated with mental
illness, reducing prolonged suffering, reducing
suicide, please discuss:
• Strengths illustrated in meeting the goals
• Opportunities to strengthen how the department
meets/measures the goals
Group Discussion
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 33
Section IV Reduce Homelessness
Reduce Unemployment
Goal: Reduce Homelessness
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 34
-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.
Behavioral HealthPrevention and Early Intervention
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.
Behavioral HealthPrevention and Early Intervention
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
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 37
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
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 38
School
Based
Programs
Section IV
Based on the data presented concerning reducing
unemployment and reducing homelessness,
please discuss:
• Strengths illustrated in meeting the goals
• Opportunities to strengthen how the department
meets/measures the goals
References
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 39
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
Closing
Behavioral HealthPrevention and Early Intervention
www.SBCounty.gov
Page 40
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.