Criteria for Value in Sustainability

1. RAND’s Recommendations for Sustaining California’s StatewideMental Health Prevention and Early Intervention ProgramsAugust 14, 2014

2. Criteria for Value in Sustainability • Does the activity fill a strategic gap? (e.g., not redundant with county-level efforts?) • Does the activity employ population-based strategies that can only be feasibly implemented at the statewide level? • Are there efficiencies in scale to be gained by statewide sustainment? • Would a relatively low-cost investment in sustaining program operations yield value and leverage already-created capacities that required a much higher start-up cost investment? • Would sustained programs have performance monitoring capacity integrated into them, so interventions can be improved over time? • Would statewide efforts contribute to the development of valued local capacity?

3. Suggested Program Activities to Sustain • Recommendations for program activities that should be considered for sustainment are based on: • Sustainability criteria • Literature reviews we conducted in each initiative area • RAND evaluation results to date

4. Suggested Activities to Sustain:Stigma & Discrimination Reduction • Social Marketing Campaign • Suggest sustaining EMM campaign and website, as • Campaign impacts are short-lived unless continued • Evaluation results show promising reach of campaign • CalMHSA should continue to target PEI efforts toward Asian Americans and Latinos. • Evaluation shows that Asian Americans and Latinos interviewed in Spanish report relatively high levels of stigma • Messaging targeting young adults should focus on how they can provide support to individuals with mental health concerns and link them to resources • Evaluation results indicate that young adults are relatively less stigmatizing & more likely to know those with mental health challenges, but unlikely to help link them to resources

5. Suggested Activities to Sustain:Stigma & Discrimination Reduction • Training in Stigma Reduction Interventions • Suggest sustaining NAMI training, prioritizing those that focus on reaching “influencers” • In Our Own Voice (IOOV) priority because evidence-based, and can be targeted to different types of audience. • Important to develop and evaluate a culturally and linguistically adapted training (similar to IOOV) appropriate for dissemination to Asian-American and Spanish speaking Californians • Consider sustaining Mental Health First Aid (MHFA) • Evidence-based • Addresses support provision

6. Suggested Activities to Sustain:Suicide Prevention • Social Marketing Campaign • Suggest continued dissemination of the “Know the Signs” (KTS) suicide prevention campaign • Evaluation found that those who saw KTS materials were more confident in intervening with those at risk of suicide • Expert panel convened by RAND concluded that KTS messaging and marketing approach better than most. • Culturally and linguistically appropriate campaign dissemination to Asian Americans and those who do not speak English • Evaluation found exposure to KTS messages was lower among these groups • Gaps in Suicide Prevention Campaign • Means restriction • Reaching the elderly, who are at higher risk

7. Suggested Activities to Sustain:Suicide Prevention • Training in Suicide Intervention Skills • Applied Suicide Intervention Skills Training (ASIST) should be targeted to and tailored for vocations that are likely be in a position to provide help (e.g., police, school counselors). • Suggest ongoing use of RAND’s fidelity and adherence protocol for improving trainer competencies. • Recommend a new focus on training primary care providers and health care organizations in depression identification and integrated care delivery

8. Suggested Activities to Sustain:Suicide Prevention • Hotlines/WarmlinesOperated by Local Crisis Centers • Continue efforts to evaluate and improve the quality of hotlines/warmlines, including regular reporting of common metrics on calls, acheivingaccreditation, and monitoring quality of calls. • Consider pros and cons of local model as compared to alternative call center models such as blended call centers (e.g., centers that also receive “211” calls) or a more centralized system. • RAND is currently developing a policy paper to help frame these issues • In-Person and Online Suicide Prevention Services • Recommend support of a diverse array of crisis services, ranging from in-person to online, based on evaluation of resource preferences.

9. Suggested Activities to Sustain:Student Mental Health • Training School Faculty/Staff/Students in Evidence-Based Interventions • Invest in a sustainable training capacity (e.g., online learning) for the most useful or in-demand trainings • Sustain trainings with a robust evidence base (e.g., ASIST, MHFA) • Broaden visibility of trainings for staff/faculty and provide incentives for attendance. • Evaluation found that <40% of faculty/staff believe they have the skills to help students with mental health problems, and the largest barrier to training participation was not knowing about trainings that were offered

10. Suggested Activities to Sustain:Student Mental Health • Websites • Recommend efforts to sustain web-based resources, and continued efforts to publicize them. • RAND evaluation suggests increasing use of websites, and they are relatively inexpensive to maintain • Collaboration/Networking • Some networks and collaborations among agencies and organizations supporting SMH have had a large impact across institutions and communities and relatively cost-effective to sustain. • School-Based Assessment • Higher ed climate survey can help inform future activities and to monitor the status of student needs • UC online Interactive Screening Program (ISP) is helpful in identifying student mental health needs

11. Suggested Activities to Sustain:Evaluation • Program-Level Evaluation • Population Surveillance • Recommend efforts to coordinate with and improve existing population surveillance systems so that they better support population tracking related to PEI efforts. • Improve standards in California for investigating and reporting death by suicide (adopt national recommendations) • Enhance the California Health Interview Survey (CHIS) • Enhance the K–12 California School Climate, Health, and Learning Survey (CAL-SCHLS) by incorporating key items into core or commonly used modules • Sustain higher education campus-wide surveys • Targeted Effectiveness Studies

12. RAND Publications • These recommendations are informed by key RAND publications: Interventions to Reduce Mental Health Stigma and Discrimination: A Literature Review to Guide Evaluation of California's Mental Health Prevention and Early Intervention Initiative Interventions to Prevent Suicide: A Literature Review to Guide Evaluation of California's Mental Health Prevention and Early Intervention Initiative  Interventions to Improve Student Mental Health: A Literature Review to Guide Evaluation of California's Mental Health Prevention and Early Intervention Initiative What Has the CalMHSA Statewide Mental Health Prevention and Early Intervention Program Done So Far? Key Results from the Baseline RAND General Population Survey Adults Exposed to “Know the Signs” Are More Confident Intervening with Those At Risk for Suicide  Racial and Ethnic Differences in Mental Illness Stigma in California Racial and Ethnic Differences in Exposure to Suicide Prevention Messaging, Confidence in One’s Ability to Intervene with Someone at Risk, and Resource Preferences, CalMHSA Student Mental Health Campus-Wide Survey: 2013 Summary Report • These publications and others are available at: http://www.rand.org/health/projects/calmhsa.html