Amanda Barczyk, M.S.W.1 & Valarie Garza2

The University of Texas at AustinSchool of Social Work1

Texas Health Institute2

OverviewI. Transformation in America

I. New Freedom InitiativeII. New Freedom CommissionIII. Role of Substance Abuse and Mental Health Services

AdministrationII. Transformation in Texas

I. Transformation WorkgroupII. Selected Communities

III. Stigma Reducing InterventionsI. StrategiesII. Effective Components

IV. Methods V. Stigma Experienced By ConsumerVI. Implemented Stigma Reducing StrategiesVII. Effectiveness of Stigma Reducing Strategies

Transformation in AmericaNew Freedom Initiative

President Bush announces Initiative in February, 2001

Aims to…Increase access to assistive technologiesExpand educational opportunitiesIncrease ability for Americans with disabilities

to integrate into workforceIncrease access into daily community living

Transformation in AmericaNew Freedom Commission

This key component was announced in April 29, 2002First in 25 years

Five Principle GoalsFocus on desired outcomesCommunity-level modelsPolicies that maximize the utility of existing

resources by increasing cost-effectiveness and reducing unnecessary and burdensome regulatory barriers

Use mental health research findingsFollow principles of Federalism

Transformation in AmericaNew Freedom Commission Cont.

Subcommittees developedFocused on smaller more specific areas

Necessary to “transform” mental health systemThe goal of transformation is “to restructure

State systems to better meet the needs of individuals with or at risk of mental health problems and their families.”

Benchmarks/goals were set to track their effort

Transformation in AmericaRole of Substance Abuse & Mental Health Services Administration The Federal Action Agenda: First Steps

Gave background of New Freedom InitiativeFocused on five principles developed by CommissionCreated initial action steps

Mental Health Transformation State Incentive GrantsSeptember, 2005, SAMHSA awarded $92.5 million to

seven states over five year periodConsumers and family members must be involvedRequired to “provide a continuum of services including

promotion, prevention, treatment, and recovery”September, 2006 $21.9 million given to two more states

over a five year period

Transformation in TexasTransformation Workgroup

TWG developed to facilitate transformationConsists of 15 agencies/organizations

Smaller workgroups developed specializing in…Consumer voiceAdultsChildren and adolescentsHousingWorkforce developmentData/IT

Transformation in TexasSelected Communities

TWG put out RFP aiming for diverse communitiesEight communities selected

Urban Bexar County Safety Net Community Collaboration Williamson County Mental Health Task Force Dallas County Unified Public Mental Health Initiative Tarrant Transformation Project

Rural West Texas Community Coalition Nacogdoches County Mental Health Collaborative Costal Bend Rural Health Partnership

Border Terrell County Behavioral Health Collaborative

Stigma Reducing InterventionsStrategies

Protest Challenges inaccurate depictions of individuals with

mental health problems by insisting on the cessation of negative stereotypes or negative images of individuals with mental health problems

Education Promotes positive attitudes through the provision of

information so that people are able to develop informed attitudes and beliefs about individuals with mental health problems.

ContactEntails an individual with a mental health problem

having a face-to-face encounter with others and sharing the personal experiences of working and living in the community with a mental health problem

Combination

Stigma Reducing InterventionsEffective Components

Patient-centeredEmpower individuals to assist in development

and implementation

Target-specificCampaign targeting a group with power and

discriminatory behaviors of that group

Study Aim

Explore the stigma experienced by communities in Texas, assess whether the stigma-reduction campaigns developed are target specific and/or use a patient-centered approach and assess the preliminary effectiveness of the campaigns

MethodsTwo phase content analysis

Phase I Interviews with representatives from seven

communities Write-ups assessed for themes

Phase II Roundtable discussions at Mental Health

Transformation Focused Forum Write-ups assessed for stigma reducing strategies

and effectiveness

Stigma Experienced by ConsumersPhase I

Three themes of stigma experiencedIndividual levelFamily levelCommunity level

Community level most predominantLaw enforcementProvidersSchool-based stigma

Implemented Stigma Reducing StrategiesPhase II

Campaigns utilized different strategiesTarget-specificCombined education and contactFocus on mental health not mental illnessConsumer participation

Only a small proportion showed an observed positive impact on reducing stigma

ConclusionsResearch shows effective strategies, however…

Stigma reducing strategies in Texas are not all effective

More implementation is needed in Texas in diverse areas

Guidelines for implementation neededPre-evaluation work with consumers

Implementation and evaluation standards needed

Questions?