From Victims to Heroes Many consumer leaders have brought their - - PowerPoint PPT Presentation

Supporting Client Culture Webinar in Two Parts

Webinar Part Two:

From Victims to Heroes

Many consumer leaders have brought their wisdom to this training.

This training was compiled and developed by the California Association of Mental Health Peer Run Organizations (CAMHPRO) Karin Lettau, MS, Director of Training & Employment, klettau7@gmail.com

Funded by the Mental Health Services Act through the Mental Health Services Oversight & Accountability Commission (MHSOAC) camhpro.org www.facebook.com/camhpro

Acknowledgements to Contributors

• Vernon Montoya
• Sally Zinman
• Gayle Bluebird
• Willy Collins
• Mary Jo O'brien
• Tina Wooten
• Maria Maceira
• Richard Krzyzanowski

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• Michele Curran
• Sharon Kuehn
• Lucinda Dei Rossi
• Jennifer Jones
• Eddy B. Alvarez
• Angela Abbott
• Karin Lettau
• And so many, many more!

Tulips are People IX

Jerome Lawrence, Consumer

Webinar Format—How to Participate

• 1. Polling Questions In-webinar, click box to choose answer. We will show

poll results.

• 2. Raise your virtual hand to be unmuted to ask a question or make

comment.

• 3. Questions box--type in question or comment, send to all presenters
• 4. At the end of the webinar please complete the training evaluation.
• 5. Contact Technical Assistance from Advocacy Coordinator after the

training. You may download all handouts from the control panel

Poll: How many watching on your computer?

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Poll: What region do you live in?

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CAMHPRO’s Mission

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• The California Association of Mental Health Peer-

Run Organizations (CAMHPRO) non-profit consumer-run statewide organization

• Members are consumer-run organizations and

programs, and individuals.

• Empower, support, and ensure the rights of

consumers, eliminate stigma, and advance self- determination and choice.

• Poll: How do you primarily identify?

Learning Objectives

For better outcomes:

• List social determinants of poor behavioral health outcomes that

permeate client culture.

• Describe how personal and systemic empowerment and recovery

has redefined consumer identity and promoted transformation.

• Specify how to apply client culture competency for more responsive

strategies for better behavioral health services and outcomes.

• Role of behavioral health providers
• Role of consumers in behavioral health policy and program planning

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Overview

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Review Client Culture Part One

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Karin Lettau, MS, ITE

Surviving the Fire & Rising from Ashes to A Million Flowers

• Phacelia

grandiflora

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You may trod me in the very dirt But still, like dust, I’ll rise. –Maya Angelou

Client Culture: A Definition

Mental health clients bring a set of values, beliefs and lifestyles that are molded as a result of their personal experiences of a mental disability, the mental health system and their own ethnic culture. When these personal experiences are shared, mental health clients can be understood better and empowered to effect positive system change.

• DMH Info Notice 02-03

Impact on Quality of Life

Diagnosis/ Labeling Medication Hospitalization Stigma

Unemployment

Economic Impact Housing Cultural, Racial and Ethnic Disparity Forced Treatment

Michele Curran

Types of Mental Health Stigma

• “Public Stigma” is the attitude and belief of the general public

towards persons with mental health challenges or their family members.

• “Institutional Stigma” is an organization’s policies or culture of

negative attitudes and beliefs.

• “Self-stigma” is when an individual buys into society’s misconceptions

about mental health.

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(Disability Rights California)

Ethnically, Culturally, Racially, Sexually Diverse Groups Face Hig igher Stressors

• Poverty, unemployment, crime,

substance abuse, incarceration

• Many cultures do not believe in western

traditional medicine or psychotropic meds

• Misunderstandings occur
• Incorrect diagnoses
• Mistrust of system
• Increased non-disclosure
• System lacks diverse staff
• High dropout rates from treatment

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Rivera: My Godfather’s Sons

Summary of the Consumer Movement

1980’s

• Begin consumer

run programs

• State CA

Consumer advocacy

• rganizations
• More consumers

are on decision making bodies

• Government

begins to fund self help & peer support programs

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2010’s

• Trauma informed

care and peer respite alternatives developed.

• California

Association of Mental Health Peer- Run Organizations (CAMHPRO)

1970’s

• Civil rights
• Big hospitals

close

• Former patients

find each other & meet to define core values and goals

1990’s

• Recovery culture

begins to replace chronicity culture

• More system-

funded self help & peer support programs

• Consumers

involved at most levels of MH system.

• Consumers begin

to be employed within system.

2000’s

• Funding amplified
• Many states

create peer certification, with Medicaid reimbursement

• Consumer

developed trainings become mainstream

• CA MHSA embeds

recovery values into law

Sally Zinman

Key CA Legislation

Mental Health Services Act (MHSA)

• Voters passed in

2004, taxes 1% of residents’ income

• ver $1 mill.
• Funds multi-

cultural, innovative, integrated services

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State law: WIC 5813.5

• (d) Planning for services shall be consistent with

the philosophy, principles, and practices of the Recovery Vision for mental health consumers: (1) To promote concepts key to the recovery for individuals who have mental illness: hope, personal empowerment, respect, social connections, self- responsibility, and self-determination. (2) To promote consumer-operated services as a way to support recovery. (3) To reflect the cultural, ethnic, and racial diversity of mental health consumers. (4) To plan for each consumer’s individual needs.

Social Determinants Affecting Behavioral Health Outcomes

Karin Lettau, MS, ITE

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Social Determinants of Health--WHO

• Social determinants of health are the conditions in which

people are born, grow, live, work and age.

• These circumstances are shaped by the distribution of money,

power and resources at global, national and local levels.

• Social determinants of health are mostly responsible for health

inequities - the unfair and avoidable differences in health status seen within and between countries.

• World Health Organization (WHO)

http://www.who.int/social_determinants/sdh_definition/en/

• See Handout SAMHSA CAPT p. 5-6

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http://kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social- determinants-in-promoting-health-and-health-equity/

Clients Have Experienced Poor Living Conditions

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A Public Health Framework for Reducing Health Inequities [Chart]. (2015). In

• BARHII. Figure 1: A Public Health Framework

for Reducing Health Inequities – Bay Area Regional Health Inequities Initiative. http://barhii.org/framework/

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By Race/Ethnicity, CA Estimated MH Conditions vs Use of Services & Poverty

1.74% 2.36% 7.07% 5.95% 4.19% 5.06% 5.91%

3.53% 4.29% 11.33% 9.20% 9.17% 7.46% 10.32% 4% 1% 18% 38% 30% 8%

14% 1% 2% 7% 39% 38% 4%

Asian Pacific Islanders Native Americans Black/African Americans White Hispanic or Latino Multi-Racial

Black/African

% of state pop. % using services SMI est. % below 200% FPL SMI Est. % prevalence

Estimated SMHC Prevalence % for CA Youth by Ethnicity and Poverty Level

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7.56% 7.16% 7.68% 7.99% 8.00% 6.86% 8.02% 7.27%

8.91% 8.94% 8.88% 9.04% 9.12% 8.80% 8.90% 8.95%

All Youth Asian Pacific Islanders Native Americans Black/African Americans White Hispanic or Latino Multi-Racial

Estimated SMHC prevalence % Estimated SMHC prevalence % below 200% FPL

Rates of Suicidal Thoughts Are Higher Among Bisexual, Gay and Lesbian Adults

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Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health

• Equity. A Report to the Legislature and the

People of California by the Office of Health

• Equity. Sacramento, CA: California

Department of Public Health, Office of Health Equity; June 2015.

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Social Determinant of Health: Trauma

• Trauma—90% of public mental health consumers

have been exposed to trauma

• DSM IV-TR:
• Personal experience/knowledge of event involving actual

threatened death or serious injury to self or another -Response to event involves intense fear, helplessness or horror

• For children, disorganized or agitated behavior.
• (Goodman, Rosenburg et al., 1997; Mueser et al., 1998)

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Poll: Choose the best list of social determinants health that permeate client culture.

Social Determinant of Health: Trauma

• Nervous System Brain chemistry changes
• Adverse Childhood Experiences

(ACE) Study & Scoring

• 10 Questions to 17,000 people
• Higher score = higher risk of illness
• 2/3 people ≥ 1 ACE
• 1/5 reported score of ≥ 3 ACE
• More information at:

http://www.cdc.gov/ace/index.htm

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ACEs and Suicide Attempts

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Compared with persons with no such experiences (prevalence

• f attempted suicide,

1.1%), the adjusted odds ratio of ever attempting suicide among persons with 7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6- 47.1)

ACEs, Hallucinations & Substance Use Issues

• Compared to persons with 0 ACEs,

those with 7 or more ACEs had a 5 fold increase in the risk of reporting hallucinations.

• Compared with people with 0 ACEs,

people with >or=5 ACEs were 7- to 10-fold more likely to report illicit drug use problems, addiction to illicit drugs, and parenteral drug use.

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Poll: What are the results of poor social determinants on people’s health?

Questions?

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Personal and Systemic Empowerment and Recovery Redefine Consumer Identity

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Karin Lettau, MS

Personal and Systemic Empowerment and Recovery Redefine Consumer Identity

• Recovery Concepts and Values
• Recovery is Expected
• Systemic Change & Empowerment
• From Victim to Hero
• Recovery Stories

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A Belief in Wellness/Recovery

“Recovery from a mental illness is not

• nly possible, it is to be

expected.”

President’s New Freedom Commission on Mental Health, 2002

See handout CAMHPRO Draft Issue Brief Recovery

Community Services & Supports Consumer & Family Run Programs Workforce Education & Training Services across the lifespan Wellness Centers Services meet needs of unserved, underserved, inappropriately served Prevention & Early Intervention

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Community Planning 15 Guiding Principles & Practices

Hope

Personal Empowerment

Respect

Social Connections Self- responsibility Self- determination Community collaboration

Client Driven

Family Driven Cultural Competence Wellness, Recovery &

Resilience Focused

Integrated Services

Roots, Veins & Fruits of the Mental Health Services Act-MHSA 2004

Consumer Values MHSA Values

Innovations

Trauma- Informed Services

Culturally Responsive Services

FSPs

Definition of Mental Health Recovery

“A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”

US Substance Abuse & Mental Health Services Administration—SAMHSA’s 2012 Working Definition

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Degas

SAMHSA‘s 2012 Guiding Principles of Recovery

• 1. Hope
• 2. Person-Driven
• 3. Many Pathways
• 4. Holistic
• 5. Mutual Peer

Support

• 6. Social Networks
• 7. Culturally Grounded
• 8. Trauma-Informed
• 9. Strengths &

Responsibility

• 10. Respect-Based

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Diversity Empower- ment Self- Help Employment Holistic

Th The Pie Piece ces s of Wellne llness ss

C h

• i

c e Client-driven Voluntary Peer Support Peer Advocacy Recovery Centered Community Based

Michele Curran

From Victim to Hero

Self-Help Works

• The term does not mean

“You’re on your own”

• It does mean “You’re

responsible” for your own care

• Personal Empowerment

and Education are the keys

From Institutionalization’s Learned Helplessness to Empowerment

• Empowerment to make

choices

• Learn from our mistakes

what works for us

Client Culture: Self-Help & Peer Support

• Hearing what others have been through
• Helping someone navigate the system and

avoid heartache

• Learning that I am not alone

“Who then can so softly bind up the wound of another as he who has felt the same wound himself?”

• Thomas Jefferson

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Redefining Consumer Identity as Survivor, Actor and Hero Promoting Transformation

• A hero is an ordinary individual who finds

the strength to persevere and endure in spite of overwhelming obstacles.

• --Christopher Reeve
• We all live in suspense from day to day;

in other words, you are the hero of your

• wn story.
• -Mary McCarthy

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Client Culture: Power of Lived Experience

• Consumers “tell their stories”
• f illness and recovery
• Video of Jamin

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Emily Carr

Spirit of Consumer Culture

• Inclusion
• Diverse skills, abilities, potential
• Celebration of cultural, ethnic, racial

diversity

• “Nothing About Us Without Us”
• People DO Recover, build resiliency

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Klee, Senecio

Poll: How has personal & systemic recovery redefined the client identity and promoted transformation?

Client Culture: Alternative MH Services

 Self-Advocacy  Self-Help & Peer Support  Peer Advocacy andSupport  Education  Political Activism  Empowerment  Spirituality  Alternatives or adjuncts to Medications

• Hope
• Social Connections
• Culture
• Empowerment
• Self-determination
• Freedom of Choice
• Responsibility
• Knowledge of Rights
• Self-Advocacy
• Peer & Other Support Systems
• Resiliency
• Meaning/purpose or spirituality

Recovery ry Valu lues Consumers know and Scie ientists have proven People DO Recover!

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Questions?

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Applying Client Cultural Competency for Better Outcomes

Christina Alejo, BA Program Director Holistic Cultural & Education Wellness Center, Fresno

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Client Culture Competency for Better Behavioral Health Services and Outcomes

▪ Remember our Collective Historical Trauma ▪ Be Part of the Solution to Eliminate Stigma & Discrimination ▪ Promote Social, Economic & Environmental Justice for Health Equity Outcomes ▪ Reduce Cultural, Racial and Ethnic Disparities ▪ Support Holistic Health ▪ Address social determinants that affect mental health ▪ Build Resiliency and Support Self- Help Programs ▪ Trauma-informed practices ▪ Seek to Understand and Honor Diversity ▪ Use Person First, Recovery Language ▪ Invite Consumers onto county and State decision making bodies to develop service policies and programs

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Client Cultural Competence: Remember Our Collective Historical Trauma

• Historical lack of freedom and

trust

• Honor self-determination and

choice

• Enhance decision-making

possibilities

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Client Cultural Competence: Trauma-Informed Services

• Strengths-based approach
• Understand the impact of trauma
• Foster physical, psychological &

emotional safety

• Create opportunities to rebuild a

sense of control and empowerment

• Anticipate and avoid re-

traumatization

• Clients involved in service

development, delivery and evaluation

• Create a peer support

environment:

• Non-hierarchical atmosphere of

mutuality

• Focused on resilience with peer

specialists as models of recovery

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(SAMHSA TIP 57, 2014, p.xix) “A Treatment Improvement Protocol Trauma-Informed Care in Behavioral Health Services”

Client Cultural Competence: Be Part of the Solution to Eliminate Stigma & Discrimination

• Having natural CONTACT with people with behavioral health

challenges reduces attitudes of stigma and discrimination

• Help EDUCATE people on MH myths
• 1 in 4 Americans experience MH issues at some point in life
• People with MH issues are less likely to be violent than others
• Employees with MH issues are as competent and reliable as any
• ther employee with appropriate training
• Welcome Peer Support Specialists as valued colleagues to the

MH workforce and to decision making bodies

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Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health

• Equity. A

Report to the Legislature and the People of California by the Office of Health Equity. Sacramento, CA: California Department of Public Health, Office of Health Equity; June 2015. http://www.cdph.ca.gov/programs/Documents/CDPHOHEDisparityReportAug2015.pdf

Client Cultural Competence: Promote Social, Economic & Environment al Justice

1998: How Does A Competent Mental Healt lth System Provid ide Services That Are Sensit itiv ive To Clie lient Cult lture? ADDRESS QUALITY OF LIFE ISSUES:

[Social Determinants]

• Housing
• Stigma
• Unemployment
• Address the real needs of the whole person
• Build community supports

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Wooten, Collins, O’Brien

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Client Cultural Competence: Promote Holistic Health

Eight Dimensions of Wellness– SAMHSA, Adapted from Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal

Client Cultural Competence: Support Recovery/Resiliency Based System Elements

• Trauma-Informed Services
• Collaborative partnerships – trust & respect
• Voluntary and appropriate medication
• Full Service Partnerships & Housing
• Peer Support & Peer Employment
• Linkage to community based supports
• Peer Run Programs
• Empowerment by shared decision making
• Participation in meaningful goals & activities

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Client Cultural Competence: Build Resiliency

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“ an inner capacity that when nurtured, facilitated, and supported by others– empowers children, youth, [adults]and families [and communities] to successfully meet life’s challenges with a sense of self- determination, mastery and hope.”

(Center for Innovative Practices, Ohio DMH) Degas

Client Cultural Competence: Support Wellness Self-Help Management Programs

• Creates environment that invites personal responsibility.
• Empowers people to make choices and discover what

works best for each individual.

• Creates opportunity for people to better understand

each other.

• Using self-help management strategies allows people to

play leadership roles in their community by teaching, modeling and promoting recovery/resiliency,

• ex. Wellness Recovery Action Planning (WRAP).

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Renoir Umbrellas

Poll: All but one answer below honor client culture. Which does NOT honor client culture?

Client Cultural Competence: Gather Needs with Outreach to Diverse Communities

• Outreach into communities, no expectation community

will come to us

• Develop relationships, working to address specific,

broader challenges within community, let them decide how

• Value faith-based organizations
• Understand that traditional culturally bound healing &

practices, in addition to, or instead of contemporary mental health practices, may be important to some persons with behavioral health issues.

• SAMSHA, 2004

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Client Cultural Competency Reflect Diverse Cultures, Ethnicities

• Create Services &

Environments Reflecting the Diverse Cultural Identities of People Served

• Staffing
• Décor
• Languages

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Client Cultural Competence: Seek to Understand & Honor Div iversity

Religious/Spiritual identity Economic class background Sexual identity

Psychological maturity Ethnic/racial identity Chronological/developmental challenges Trauma and other threats to one’s well-being Family background and history Unique physical characteristics

Location of residence, and language differences

• Multidimensionality RESPECTFUL MODEL D’Andrea and Daniels 2001

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see Handout

Ashcraft, L. & Anthony, W., Tools for Transforming Language, in Behavioral Health Care, 2006

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Disrespectful Respectful & Accepting Uniqueness

decompensating

not him/herself today, experiencing symptoms

manipulative resourceful, trying to get help crazy unique noncompliant think for themselves, taking responsibility entitled aware of their rights resistant chooses not to, has own ideas frequent flyer provides many opportunities to help unmotivated has other interests, bored helpless unaware of capabilities hopeless unaware of opportunities grandiose has high expectations

Client Cultural Competence: Use “Person First“, Recovery Language

Client Cultural Competence: Inclusion, It’s the Law

“Counties shall demonstrate a partnership with constituents and stakeholders throughout the process that includes meaningful stakeholder involvement in mental health policy, program planning, and implementation, monitoring, quality improvement, evaluation, and budget allocations.” WIC Section 5848. (a)

CA Mental Health Services Act (MHSA)

County Behavioral Health Boards must:

• Have disclosed consumer members
• Review County Three-Year Program & Expenditures Draft Plan & Annual

Updates

• Circulate for review for a 30–day comment period
• Hold Public Hearing on the Draft Plan at end of 30-day comment period

Prior to vote on Draft Plan by Board to approve

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Client Cultural Competence:

In Invite Dis isclosed Consumers onto Decision Making Boards

• We have survived the fire, we have risen from the ashes, we are heroes of
• ur lives, and are the evidence recovery happens, as hope for others.
• We are the experts of our lives, of what each of us need in difficult times,
• f what has worked for each of us.
• We can bring our communities together to identify what our unique needs

are, where the gaps are, culturally-responsive alternative services to compliment traditional services

• We must be at the local and State decision-making tables to bring our

perspective and solutions

• County Behavioral Health Advisory Boards
• State Advisory and Planning Councils

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Poll: Which of these are NOT client culturally competent?

Questions?

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Action

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Lifework

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Know Thyself Self-Exploration

• Explore how you, a family member or

close friend felt like a ‘victim’ in some way at one point, and what helped you, your family or friend in the process from feeling like a victim to becoming an actor, survivor

• r hero.
• Find a virtual classmate, colleague or

friend to share your insight with.

• What can you take from this exercise
• to help you support another person in a

similar process in the future?

• to help improve services and policies?

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Picasso: Jeune Fille Devant un Miroir 1932

Questions?

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Please Complete Post-Survey Right After This!

• It only takes a minute
• Thank you in advance!

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References

Ashcraft, L. & Anthony, W. (2006). Tools for Transforming Language, Behavioral Healthcare,

• April. http://www.behavioral.net/article/tools-transforming-language

California Department of Public Health, Office of Health Equity. (June, 2015). Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity. A Report to the Legislature and the People of California by the Office of Health Equity.

• Sacramento. Retrieved on June 15, 2016 from

http://www.cdph.ca.gov/programs/Documents/CDPHOHEDisparityReportAug2015.pdf. California Network of Mental Health Clients, State of California, Department of Mental

• Health. (June, 1998). Client Culture Training/Focus Groups Project Summary Report and
• Presentation. [unpublished]

Chamberlin, J. (1978). On Our Own: Patient Controlled Alternatives to the Mental Health

• System. New York: Haworth Press.

D’Andrea, M., & Daniels, J. (2001). Respectful counseling: An integrative multidimensional model for counselors. In D. B. Pope-Davis, & H. L. K. Coleman (Eds.), The intersection of race, class, and gender in multicultural counseling (pp. 417-466). Thousand Oaks, CA: Sage. Kaiser Family Foundation Health Tracking Poll: February 2013 (conducted Feb 13-19, 2013). Retrieved on June 15, 2014, from http://kff.org/disparities-policy/poll-finding/kaiser-health- tracking-poll-february-2013/. Office of Statewide Health Planning & Development WET Five-Year Plan Assessment: Report 6 - Public Mental Health Services Demand/Users (September 2014). Retrieved on November 15, 2015 from http://www.oshpd.ca.gov/HWDD/2014/WET/reports/Report-6- Workforce_Demand.pdf. RAND Health. Wong, E., Collins, R., Cerully, J., Seelam, R., & Roth, E. (2016). Racial and Ethnic Differences in Mental Illness Stigma and Discrimination Among Californians Experiencing Mental Health Challenges. Samuels, J. Schudrich, W., & Altschul, D. (2009). Toolkit for modifying evidence-based practice to increase cultural competence. Orangeburg, NY: Research Foundation for Mental

• Health. Retrieved on December 9, 2016 from http://ssrdqst.rfmh.org/cecc/.

Substance Abuse and Mental Health Services Administration’s Center for the Application of Prevention Technologies, Center for the Application of Prevention Technologies. (October, 2016). Tools from the CAPT: Increasing Cultural Competence to Reduce Behavioral Health

• Disparities. Retrieved on December 15, 2016 from

https://www.samhsa.gov/capt/sites/default/files/resources/increasing-cultural-competence- reduce-behavioral-hd.pdf Substance Abuse and Mental Health Services Administration. Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication

• No. (SMA) 13-4801. Rockville, MD: Substance Abuse and Mental Health Services

Administration, 2014. Retrieved on January 21, 2015 from http://store.samhsa.gov/shin/content/SMA14-4816/SMA14-4816.pdf World Health Organization (2016) website. Social Determinants of Health. Retrieved on December 20, 2016 from http://www.who.int/social_determinants/sdh_definition/en/ Zinman, S. (2009). The history of the mental health consumer/survivor movement. Presentation on December 17, 2009, sponsored by SAMHSA’s Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health. Retrieved on November 15, 2016 from http://www.mindlink.org/dwnld_docs/samhsa_history_consumer_movement.pdf

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