CALIFORNIA CENTER FOR DIGNITY , SOCIAL INCLUSION & STIGMA ELIMINATION

CALIFORNIA CENTER FOR DIGNITY, SOCIAL INCLUSION & STIGMA

ELIMINATION

Exploring Efficacy and Innovation in Stigma Reduction

CASRA Spring Conference “The Power of Connection in a

Time of Change”

April 12, 2012

Eduardo Vega, MPHExecutive DirectorMental Health Association of San FranciscoCo-Principal Investigator Center for Dignity, Social Inclusion and Stigma Elimination

Glen McClintock, MSWProject ManagerCenter for Dignity, Social Inclusion and Stigma Elimination

Richard KrzyżanowskiResource Development Program ManagerCenter for Dignity, Social Inclusion and Stigma Elimination

The California Center for Dignity, Social Inclusion & Stigma Elimination

CALIFORNIA CENTER FOR DIGNITY, SOCIAL INCLUSION & STIGMA ELIMINATION

Mission: To advance human dignity and wellbeing on a sustained basis by changing behavior and bias associated with mental health and mental illness in California through integrated evaluation, refinement and dissemination of best practices in stigma reduction that are effective in the state’s many communities; and to advance the field of stigma and discrimination practice and research globally.


Center Objectives and Core Values


Center Core Values Lived Expertise in the effects of mental illness

and stigma Interdisciplinary Approaches Recovery, Compassion, Dignity, Hope & Self-

determination Efficacious use of Community Resources Consumer and Family Empowerment


Center Core Values

Cultural Competence, Linguistic Diversity and Cultural Effectiveness

Community Expertise Community Empowerment Life at all ages Youth Empowerment.


Center Objectives


Center Objectives Drive research on what really works in stigma reduction into

practice across California Actively collaborate with other SDR programs and projects

statewide to achieve maximum impact. Establish strategic areas of SDR practice improvement and

innovation Identify programs that are most effective culturally

and cross-culturally; advance the R&D of these in multiple communities and advance the field of SDR knowledge and practice across cultures and linguistic barriers

Advance the field of SDR knowledge and practice internationally through excellence in SDR practice evaluation, development and dissemination


Center Objectives Promote empowerment of clients/consumers

and youth as change champions informed by research and best practices

Empower California communities and grass-roots organizations with tools, knowledge and training for implementing best practice SDR

Create tools and sustainable frameworks for programs to evaluate themselves and their outcomes for SDR


Center Objectives Establish parameters for and engage cross-

systems evaluation and evidence-based projects Assist in development of trainings, manuals, etc.

for promulgation of leading and best practices Develop evidence-based, best and promising

practices database or clearinghouse Establish the Center as a sustainable

stigma TARTC and research entity in California and internationally


Technical Assistance Research and Training Center (TARTC)

The goal of the TARTC model is to simultaneously evaluate, support and advance leading and promising practices into implementation through tightly integrated research and development and rapid knowledge transfer.


Technical Assistance Research and Training Center Model

3 Core Units1. Research/Evaluation2. Training/TA3. Communications & Dissemination


Current Projects


Promoting Efficacy and InnovationEvidence Based Practices

Promising Practices

Best Practices

Emerging Practices

Outc

ome

Eval

uatio

n


CalMHSA ProgramsResource Development Will Identify stigma reduction programs, providing research and

evaluation of the most effective strategies for reducing stigma, with the hope of bringing these strategies into practice statewide. This project will partner community leaders in stigma reduction across California with the National Consortium on Stigma and its director, Dr. Patrick Corrigan, a Co-Principal Investigator.


CalMHSA Programs

Promising Practices Will engage with California communities to examine cultural strengths

and resources; identify culturally specific attitudes towards mental health; and support approaches that reduce stigma within the State’s culturally, ethnically and linguistically diverse communities. This research will be led by Dr. Sergio Aguilar‐Gaxiola, Co-Principal Investigator and director of the UC Davis Center for Reducing Health Disparities.


Relationship with Promising Practices and Resource Development

Resource DevelopmentProgram already primarily identified as SDR

Leaders may already be part of existing networks

Identification based on assumptions within the culture of mental health/ SDR services

Promising PracticesPrograms not previously identified

Community stakeholders/leader may be primarily unknown

Cultural needs may not be readily acknowledged/understood


Promoting Efficacy and InnovationEvidence Based Practices

Promising Practices

Best Practices

Emerging Practices

Outc

ome

Eval

uatio

n


The Challenge: Stigma and Stigma Change


Some Definitions of Stigma A mark of disgrace or infamy; a stain or reproach,

as on one's reputation. An attribute, behavior, or reputation which is

socially discrediting in a particular way: it causes an individual to be mentally classified by others in an undesirable, rejected stereotype rather than in an accepted, “normal” one.


• Public stigma• Self-stigma• Structural stigma• Label avoidance(No treatment =no labels = no shame)

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Varieties of Stigma


Self Stigma The prejudice which people with mental

health issues turn against themselves. Defined as negative attitudes about

mental health challenges and its treatment that are held by the individual with the stigmatized condition.

Has been cited as a major public health concern, contributing to decreased treatment seeking, lowered self-esteem, and lowered self-efficacy.


Self StigmaMany people with serious mental issues are

challenged doubly: On one hand, they may struggle with the symptoms and disabilities that result from the condition.

On the other, they are challenged by the stereotypes and prejudice that result from misconceptions about mental illness.

As a result of both, people with mental health challenges are robbed of the opportunities that define a quality life: good jobs, safe housing, satisfactory health care, and affiliation with a diverse group of people.


Some Hallmarks of Stigma Confounding facts and fallacies A set of social attitudes with institutional

implications Not always negatively phrased or ill-

intentioned Legacy of Paternalism


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STEREOTYPES: People with mental health issues are: fragile, unstable, violent, dangerous OR childlike, lovable bafoons (“benevolence stigma”)

PREJUDICE: They are bad because they are: scary, shameful, unpredictableDISCRIMINATION: So, don’t hire, serve, rent to them

Social constructs


The Effects of Public Stigma and it’s impact on Social Inclusion Lost employment Subpar housing Worse health care Worse education opportunities Diminished legislative support Alienated from faith communities Coercive treatment


Insurance CoveragePeople with mental health conditions are:

• Twice as likely to have been denied insurance.• Less likely to leave job in fear of losing

insurance.• Twice as likely to delay care seeking.• Twice as likely to obtain needed medical care.

Druss and Rosenheck, 1998


Stigma Change:What do we know works?


Strategies Education

Review key myths and facts that counter these myths Protest

Take people to task for stigmatizing images

“Shame on you for thinking that way!” The rebound effect: ”The White Bear”

Contact


Contact Contact with people who have mental health issues

tends to decrease stigma Meeting people who have mental health challenges

weakens people's tendency to link mental illness and violence

Corrigan, P.W. (2005). On the stigma of mental illness: Practical strategies for research and social change. Washington, D.C.: APA.

"If you focus on the competence of people with mental illness, that tends to lead to greater tolerance.”

Pescosolido, B.A., Jensen, P.S., Martin, J.K., Perry, B.L., Olafsdottir, S., & Fettes, D. (2008) . Public knowledge and assessment of child mental health problems: Findings from the National Stigma Study—Children.

Journal of the American Academy of Child & Adolescent Psychiatry, 47, 339–349.


Education vs. Contact• Education increases knowledge but

knowledge does not seem to change attitudes.

• A media-based anti-stigma campaign reaches a broader population

• Direct contact (“In vivo”) approach has a bigger impact


Meta-Analysis of Public Stigma Change:Contact, Education, and Protest

8200 papers, 71 articles, 79 studies, 612 ESs

38,362 Ss, Med=150.0 (range 19 to 7225)

Outcomes: Attitudes Affect Behavior Knowledge

Corrigan, Morris, Michaels, Rafacz, & Rusch, in review


Mean effect by anti-stigma approach: overall attitudes, affect, and behavioral intention


Mean effect sizes by anti-stigma approach – RCTs only: overall, attitudes, and behavioral intention


• Targeted• Local• Credible• Continuous• Contact

Best Practices: Strategic Stigma Change (SSC): Five Principles for Social Marketing Campaigns to Reduce Stigma

Patrick W. Corrigan, Psy.D.

TLC3


Targets• Landlords• Health care professionals• Teachers• Legislators• Employers


How Can the Center help Eliminate Stigma?


Technical Assistance Research and Training Center Model

3 Core Units1. Research/Evaluation2. Training/TA3. Communications & Dissemination


Logic Model

Inputs

Outcomes

The Center for Dignity,

Social Inclusion,

and Stigma Elimination

Sche

dule

Scope

Cost

Project Management Framework


Research &

Evaluation Team

RAND

Outreach & Disseminatio

n Team

Logic Model

Inputs

Outcomes

Training & Technical Assistance Team

CCDSISE Advisory

Board

MHASF

Sche

dule

Scope

Cost

Quality

Project Management Framework


Identify opportunities for Dissemination

Submit opportunities to Outreach and Dissemination

Team

Outreach and Dissemination

Team coordinates Dissemination with project coordinator

Provide update on effectiveness of

Dissemination Plan

Identify existing SDR Programs

Submit programs to Research and Evaluation Team

RET identifies Index and

Refines parameters of

programs

Utilize new information to

refine identification

process

Identify Training & Technical

Assistance Needs

Submit needs to Training & Technical

Assistance Team

Training & Technical

Assistance Team matches needs with Resources

Report feedback on effectiveness of


Assistance Efforts

Outreach and

Dissemination Team


Assistance Team

Research and

Evaluation Team


Project Partners An example of the Power of Connection in a time of change


PEERS Envisioning and Engaging in Recovery Services (PEERS)(Oakland)PEERS is a consumer-run organization that promotes wellness for people with mental health difficulties and their families through community outreach, empowerment, education, advocacy for social inclusion, and elimination of stigma and discrimination. Project Return Peer Support Network (Los Angeles)PRPSN offers its ever-widening circles of empowerment and integration through involvement in our self-help groups and Warm Line, membership in our centers, and independence through employment and advocacy.

Center Project Partners


Family Youth Roundtable (FYRT)(San Diego)Family Youth Roundtable is an independent family and youth led organization. The foundation of our work is to build an interconnection between the families and youth receiving services and the public child-family serving agencies that serve our communities. Public agencies such as: Children’s Mental Health, Juvenile Justice, Education and Child Welfare

California Youth Empowerment Network (CAYEN)(Sacramento)CAYEN influences policy by engaging our all TAY Steering Committee, adult advisory committee, and other people from across the state that care about mental health for youth and young adults. With input from these important voices we advocate, engage in policy discussions, and participate in state level committees to ensure that the youth voice and youth needs are included in all policy decisions around mental health services for TAY.



The Racial & Ethnic Mental Health Disparities Coalition (REMHDCO) (Sacramento)is a statewide coalition of non-profit state wide and local organizations whose mission is to work to reduce mental health disparities through advocacy for racial and ethnic communities.



What can we do for you?


Center (TARTC) Goals

Establish a Database Clearinghouse of information regarding identified SDR programs and SDR Promising Practices across California.

Provide technical assistance and training to support the development of quality, (best practice) SDR programs and SDR Promising Practices.


Clearinghouse Database Index: Age Ethnicity Language Targeted Goals Type of Stigma Geography Targeted

Community

Approach Venue Medium Other Diversity ?


Quality Technical Assistance available July, 2012 Engage in co-learning dialogue with both identified

SDR Programs and SDR Promising Practices to identify program strengths and areas of development

Utilize Development Tool (SDR Fidelity Measure) to align program with Best Practices

Provide feedback and support for future program development

Provide ongoing follow-up


Community Development Partners

Community Investigators

Youth Champions / Young Investigators

Final thoughts – Creating Living Laboratories


Questions? / Thoughts?


Glen McClintock, M.S.W.Project Manager

California Center for Dignity, Social Inclusion, and Stigma Elimination

Mental Health Association of San Francisco870 Market Street

San Francisco, CA. 94102Phone: (415) 421-2926 Ext. 320

Cell (802) 279-3936Fax: (415) 421-2928

[email protected]

For more information please contact:


The Mental Health Association of San Francisco advances the mental health of the people of San

Francisco and leads the global community in advocacy, education, research and supports that promote recovery and wellness while challenging

the stigma associated with mental health conditions.

Learn more and join us at http://www.mentalhealthsf.org

http://www.mha-sf.org/

CALIFORNIA CENTER FOR DIGNITY , SOCIAL INCLUSION & STIGMA ELIMINATION

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