Berkeley Mental Health MHSA Prevention Early Intervention

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Berkeley Mental Health MHSA Prevention Early Intervention Powered By Docstoc
					              Berkeley Mental Health
       MHSA Prevention & Early Intervention
Date: 22 April 2008
Group: Children & Families
Location: 1947 Center St. Berkeley, CA

# of Participants: 17

Agencies Represented: Rosa Parks Collaborative, Berkeley Unified School District,
Family Member of Consumer, Through The Looking Glass, A Better Way, Alameda
County Planning Council, Fred Finch Youth Center, Berkeley Mental Health
Family, Youth & Children’s Services (FYC), Albany Project FYC, LifeLong
Medical West Berkeley Family Practice.

   I. Introductions
          -   Introduction of process by Karen Klatt
                  i. What you said about budget available is that for 0-25, you said
                     something about 50%? (51% at least will go to that (youth)
                     population, but the planning panel may push to say we want
                     to increase that amount and then the final decision will be on
                     Harvey (head of BMH))

                 ii. And where would the other half go? (The rest of the
                     populations, adults, older adults)

                iii. Total allocation for Berkeley Mental Health is? ($622,500) of
                     which 51% minimally will be allocated to children/youth?

                iv. So we’re talking $300K? (Yes) well let’s go home. (What
                    people will want to look at are things that partner with other
                    services that are going on, maybe other funding pieces,
                    funding streams a big part of the whole PEI guidelines is to
                    leverage can be in kind services, furniture using time for
                    something, say a psychiatrist goes over here, health workers
                    goes over there, getting creative to stretch pot further, so for
                    this pot you want to be creative with your strategies, or if it
                    comes down to it and every one is on board and says let’s put
                    the whole pot there, but in my mind it’s about being creative
                    and collaborating, whereas if everyone fights for their piece,
                    there’s a little bit here and a little bit there, in the end
           planning panel decides) Panel is divided how? (Larger group
           learns about all the strategies and needs, then split in to three
           sub-groups: children/families, underserved, and
           consumers/family, so each group gets to look at needs
           relating to that group and agree on best strategies to address
       v. What about TAY (Transition Age Youth) population?
      vi. There is no state guideline as to which group transition age
          youth goes out of, it could go out of either adult or youth or
      vii. (funding stream goes 0-25, but where it actually lives is at
           different places, adult clinic or . . . for example right now FYC
           has contract with Alameda County to provide TAY Tip, there’s
     viii. I think guidelines in terms of intervention, it has to be short-
           term, less than a year, PEI has to be short-term, just for the
           intervention term

      ix. Not for treatment, (no) it’s about early intervention services and
          prevention education and support (this pot of $$ is supporting
          just PEI on the continuum)
       x. And the state was really clear about prevention being important
          and that they were upset that people were more focused on
          early intervention. (The County (Alameda) made it clear that
          there is a special exception being made for people experiencing
          first break)
      xi. Right because there’s research showing that early intervention
          at first break is effective
      xii. (There are also state initiatives that are taking place at the same
           time, so there will be other funds available)
     xiii. But those are going to accept proposals from districts for
           funding, Student Mental Health Initiative is going to be a
           separate pot of money (right)
-   Lisa Vargas presentation about data brought forward from
    comprehensive needs assessment (see handout)
-   Was part of your group on kids who have attendance truancy issues?
    (we did bring kids in minimally, it would have been ideal to do more
    with focus groups with youth and we’re moving into that, but
    there’s more of a youth development focus now,) I’m wondering if
    truancy piece as a prevention to juvenile justice system would overlap
    or be additional? (It would overlap, but part of the problem is that
    kid doesn’t’ feel safe and supported at school and the problem is that
    some kids don’t feel safe and supported at home either so why go to
    one more place where they don’t feel it, they’d rather be with
    friends)(There’s a lack of coordination, kids end up in juvenile
    justice system or with probation officer in Alameda County, and
    they end up at B-Tech, where they’re starting to have better wrap
-   The thing is that it starts earlier, like 4th or 5th grade, much earlier, kids
    are bounced place to place, leaving homes where kids are getting beat
    up, getting ‘incested’, and early ears and eyes in schools to identify
    these kids are crucial.
-   Truancy is like one of those triggers that, one of those events that
    would trigger a referral into the system. We’ve treated, as a board
    member, I see the system roll out and you see the spottiness of students
    coming to us for attendance issues some of whom have had great
    interventions some of whom have had none at all, so you see there are
    holes in system.

-   Information for kids before k-12 system is that in there too? (Tracy
    will talk about that, have to reach them before school; also reaches
    down to pre-k and daycare as well)
-   Did you have any findings specific to kids with disabilities or parents
    with disabilities? (Haven’t identified what the risk factors are. I
    don’t know if that’s clearly identified as one of the risk factors,
    there could be additional risk factors, however a tendency to over-
    identify kids with learning disabilities, particularly African
    American kids, when they come to school there’s no exception made
    for them, because they don’t have the same support at home, they’re
    expected to come with what every “well deserved” child has and
    they start to fall behind and as the years go on they fall more and
    more behind, because they never had sufficient support)
-   It became apparent in my work, that our students labeled as special-ed
    are not held by school system as a whole. We’re missing an approach
    to all children, the whole child, so as we’re building a system of the all
    children it becomes inclusive of all children,
-   Right as long as there’s expertise within the system; mental health
    expertise about disability in the system that’s been a big problem for a
    long time
-   Also, there’s no system at all for birth-5 kids to connect them to school
-   Linda Rudolf, Health Officer for Berkeley, Director of Public
    Health Division presentation: looking at disparities to access,
    particularly for 0-5; “everything starts in early childhood, pregnancy –
    kids get to school. If you look at data and you can see it in Berkeley
    data as well as state and national, kids from certain groups start school
    way behind other kids, mainly low income and it’s not that they don’t
    have same inherent capacity as kids from more advantaged
    backgrounds, they face a lot of stressors that we don’t pay attention to,
    and when we have opportunities to intervene, for us one of the most
    important things we can do with this opportunity is to set up a system.
    We’re tracking with work going on in Alameda County and other
    counties around state and country and world, for universal screening
    assessment referral and treatment for young children 0-5 even with
    more emphasis with 0-3; because we know the earlier we intervene
    with these kids the better the outcomes. You can take kids who have
    substances abusing parents, been abused, very depressed moms who
    have not interacted with kids in way needed, who have all these risk
    factors, you can intervene early and improve all these outcomes,
    health, education, employment, juvenile justice, if you make an effort
    to find these kids at risk for developmental, emotional and behavioral
    problems you can change the course of their whole life, so that‘s what
    we’re doing, making sure every child in Berkeley has the opportunity
    for a healthy life and if we could reduce disparities for readiness,
    cognitive, emotional, behavioral, that would be one of the best ways to
    reduce graduation and health inequities in community. We’ve been
    working on a birth–5 action team; what would it take? Treatment end,
    for most kids not talking about intensive interventions, community
    based interventions, playgroups, parent support, parent classes,
    linkages between childcare and pediatric and mental health
    providers/experts. If you intervene early they don’t need long drawn
    out treatment course, need some hand holding, help dealing with
    normal child behaviors, identification of kids who have had smoking,
    alcohol and other substance abuse during childhood and habits in
    parents that make it more destructive and for kids who don’t respond
    to the early interventions there’s a handoff to next level
-   Would you hope that support would continue when they get to
    kindergarten? (Yes we want a system where there’s warm handoffs
    all along, at least when kids get to k, there’s something there for
    every kid, k teachers have training to identify, they don’t always
    know how to respond, we have al to of kids going to special-ed
    because teachers don’t know what else to do with them) Just seems
    like a continuum is really essential. I know kids who great work was
    done then they get to kindergarten nothing was sent, except me saying,
    this kid has trouble and it took 6 months to get expelled, but there was
    a break there and no one even mentioned it
      -   I hear you using prevention dollars for someone who doesn’t have a
          diagnosis, I work in a clinic and it’s really tough providing those
          services that won’t get reimbursed (Yes but with really limited dollars
          you need to start somewhere, our belief is to start with children in
          low-income, it’s like juggling; Most of us can juggle one ball, and
          many can do two, but there’s fewer of us who can juggle three and
          I’ll bet no one in here can juggle four balls. There’s a linear
          relationship between the number of risk factors and . . . when I
          think about where do I want to start, it’s low-income kids, I want
          to go to MediCal and make sure they understand every kid needs to
          get validated screening regularly)
      -   I think its important to note; we need to focus on parents with
          disabilities and parents of kids with disabilities and medical issues, a
          lot of them might not be low income, they might be heading towards
          low-income, but if you focus on only low-income, then you’re missing
          quite a bit (Absolutely)

      -   (As well as the kids who didn’t start out in Berkeley and move here
          later, making sure their services continued)

II. Question 1: From your perspective, what are the gaps that exist and how do
      they tie in to priority needs/populations? Which of these needs is most
      important to you? What kind of strategies could be used to address them?
      -   Co-occurring disorders overlap in a lot of areas, is that being conceived
          of in mental health or separate? I know Alameda County is doing
          something; in joining with Alameda County is that part of the thinking
          for integrative care? (Berkeley has started its kick-off, neither has
          been as successful as we’d like to be. There is a hope that in some
          way that piece will be overlaid across the board, preventatively
          there would be a requirement to create a PEI strategy, but as of yet
          it hasn’t been laid out)
      -   And again, I am not presenting from school district, it was integrative
          approach, 0-5 action team is multi-agency work, integrated effort

      -   (Life Long Medical Care advocate entered discussion) I’m interested
          in 0-3, we’ve developed some excellent programming for PEI, we run
          century pregnancy and group care, women and men go through care
          together, with partners, we now have a continuum where you go
          through first year of the child’s life with a group. I attend a lot of those
          groups, and I provide prevention through a lot of those groups, but not
          all because we can’t have physician and mental health provider at
          group at same time, because it won’t get reimbursed. So it comes down
          to which is more important, and we got other grants, looking at other
    populations coming to clinic and looking to see if they’re interested in
    doing the same thing, we’ll have grant funding for one or two years
    and then the sustainability falls out. You get your startup funds and
    then how do you continue past that unless one of the family members
    has MediCal and then you’re sort of past the point of pre-diagnosis.
    (Who are in these groups?) Most of the time it’s moms and babies, but
    dads are welcome to come.
-   On the same theme, a lot of our problem has been people with
    disabilities don’t necessarily seek out care that, if I go across the issues
    there’s certainly Disparities in Access to Mental Health Services.
    Depression in women with disabilities, they tend not to seek out care.
    That has big effects in pre-natal care and is significant for children.
    They are also, there’s a tremendous amount of Psycho-social Impact of
    Trauma: medical trauma, abuse and trauma. In women with
    disabilities it’s pretty much universal, then into the issueof At Risk
    Children, youth and Young Adult Populations, we have big issues
    needing to do very concrete prevention work, like doing baby care
    adaptation, or women with cognitive disabilities, preparing for birthing
    and relationship with child and that’s not covered by anything. And
    we have big problems with EPSDT (Say more about care) Need to do
    (care) so there’s not a crisis and removal at birth, some of those are
    very crucial for the stability of family and of the parent. We have
    EPSDT medical for children, wonder for early intervention 0-5, but
    there has to be some sort of symptom for a child, we don’t really want
    to wait until there’s a symptom in a newborn baby, by the time there’s
    a symptom great damage has been done. If we have a mom with
    depression or psychiatric disability it’s predictable that there will be
    damage, or risk of damage, but we want to intervene early to prevent
    that damage. (What does that look like?) Home visiting, we work
    with whole family, between baby and parent and then practically, case
    management, whatever’s needed, sometimes a multitude of things,
    tend to have very stressed families, and Stigma and Discrimination. Of
    course that goes up there too.
-   I’m from Albany, and I want to speak to the question on what are we
    doing for prevention, addressing all areas at once: Dispartities in
    Access to Mental Health Services; Psycho-Social Impact of Trauma;
    At Risk Children, Youth and Young Adult Populations; Stigma &
    Discrimination. . . from what I understand Albany project was giving
    birth in large part because there was a suicide at Albany high, a
    Korean immigrant. There was also a suicide at the middle school, so
    issues of the Psycho-social impact of Trauma and of At Risk Children,
    Youth and Young Adult Populations and depression and particularly
    with immigrants and Asian immigrants is huge and the short time I’ve
    been in Albany, despite stereotypes some people might have, about
    50% of referrals are from immigrant families, working poor, families
    where the parents and children are like ships passing in the night, no
    one eats together, no one has time to come to school. There’s this
    disengagement, more and more depression, a lot of Stigma and
    Discrimination. They’re not knowing how to outreach, cause there’s
    Stigma and Discrimination about doing it, becoming more and more
    vulnerable. Also huge issues around grief and loss and trauma in
    general. This was born out last summer involving homicide/suicide in
    a family. It happened the first day of summer school. Can’t ignore
    major impact on immigrant families minority families with issues of
    trauma, and grief and loss with respect to what did I try to do beyond
    just individual counseling, helping to do counseling, so students
    referred by teachers, counselors, or staff, appearing to be depressed
    isolated disengaged, without any requirement I can outreach to them
    and support them on academic, social and emotional issues. One of
    my clients is tri-lingual and is outreaching to parents to engage them in
    mental health services wanting to lessen impact of trauma, letting
    them know how to cope in healthy way with loss depression and grief,
    so they don’t have lasting effects, those are concrete ways we can
    provide services. Right now there’s one of me, to serve all schools in
    elementary and high school and alternative high school. We do have
    special program to outreach to immigrants (other immigrants too?)
    Albany is one of most diverse, seeing populations from Africa,
    Rwanda, Kenya, Peru, China, Korea, all over the world. India,
    tremendous population diversity.
-   Connection between supporting culture and social emotional
    wellbeing, as a parent of a child in upper grades and as former early
    childhood teacher, that’s not well incorporated. So for early
    intervention strategies students feel as though services or teacher don’t
    have capacities to support culture. There’s a strong connection
    between helping teachers be more culturally responsive and to see that
    as important part of what they’re doing in the classroom. I think that’s
    really challenging in light of what they are doing in classroom, and it
    becomes secondary. And second thing, in terms of Disparities in
    Access to Mental Health Services. I think that the need for there to be
    a diagnosis or medical status means there are many children who
    common members teachers identify as at risk but not at risk enough for
    services and they fall through crack and if they don’t have MediCal
    status, they can’t receive services, so I think that having the teacher
    support a number of children with strategies is very important, you
    have to have a mental health consultation with teacher (what would
    that look like?) generally a mental health consultant comes into a
    center or family childcare home and partners with staff and many
    times several classrooms they identify what are strategies that in
    classroom environment can impact most children and as well as
    second pair of eyes and ears that can say “this is normal behavior and
    this is not”, also do staff to staff and family workshops.
-   In terms of needs, around the Psycho-social Impact of Trauma.
    There’s a significant need in Berkeley apart from diagnosis,
    recognizing what trauma is, early screening or identification or support
    for high risk factors, there’s not a lot of that not a lot of parent-teacher
    training; consultations of what that looks like, education, you may
    have child who starts to hit all of a sudden, immediately a behavioral
    intervention takes place, which is good but no thought about was is
    going on in home that might have led to that and that starts to lead to
    trauma event. Someone said yesterday it’s repeated trauma, sometimes
    it can be worse, more pervasive. The system has to work together with
    early intervention to support.
-   The Incredible Years goes in and works with teacher and students,
    does consultations to work with them in this way, but you don’t have
    access unless you have access to (program name, EPK?) and like
    Kidango. There are systems that are built in to do this, youth are
    disenfranchised because other people are used to a certain amount of
    trauma and are not identifying themselves as needing support. Being
    able to talk about what it is, and talking about people who have co-
    occurring disorders in their families, family is struggling so that CPS
    isn’t involved. There are a lot of “normative’ elements to families that
    keep them from being eligible or on the radar for issues.
-   What we are doing well, by having services in primary health care
    center versus school center, we meet them because they come for
    health care. I think it’s an important point, where to reach people. And
    then I also wanted to add, the impact of trauma, and I would say as
    well as the kinds of trauma we have in an urban setting, Berkeley is
    different in that it’s a safe refuge for people from around the world so
    we have parents who have extraordinary trauma such as being tortured
    and political prisoners and we have to be aware, these people may not
    qualify for services.
-   Last year in public schools we had 316 homeless children, includes
    children sleeping on floors and couches, probably 100 of those in
    Berkeley High, they’ve been raped, abused, moved from house to
    house. They would never say they have mental health issues, they are
    quirky, swap clothes, and are not noticed, but they are deeply
    traumatized, sometimes from age 2 on, no constant mothering; and
    mothers, when they show up, are equally traumatized. Unless we have
    a place where they can congregate and the only place they consistently
    congregate is at school, so having (early intervention) at sites where
    they are not necessarily therapy, they are having watching eyes,
    watching for risk and homelessness. Whether you can see it or not you
    can count on it, if you have people in places where kids are, health
    care centers, schools, parks, wherever they are, have the system in
    place. Also moves in to school, if there’s a break, doesn’t matter how
    good the work is, if there aren’t eyes watching then they’re going to
    end up at YEAH.
-   Early intervention is not itself a diagnosis. We do have of those 300+
    kids some are functioning and some with watchful eyes can go on to
    get degrees and do great things.
-   That school, I don’t care how good they are, they can’t say it’s a
    healthy school; a kid isn’t going to go a whole year and to get expelled
    at 9 years old, it’s just crazy.
-   0-3, we work mostly with children who are in the system, providing
    intensive services and we‘ve been moving towards working on child
    caregiver relationships and helping caregivers develop a capacity to
    form secure attachments with children, but in a way that breaks down
    the skills and shows what it means to have skills in very basic way. We
    assume they automatically know but often times cues are misread, or
    there are intergenerational patterns of trauma that make it so kids can’t
    read cues accurately. So we do prevention around strengthening infant
    caregiver relationships. (What kinds of things are you doing?) Being
    able to assess parents skills, being able to provide them with very basic
    skills to identify the needs, pride skills, what does it take to be able to
    follow a child’s play? To think reflectively, to follow them, lead, to
    support their socio-emotional needs, to support in positive ways and to
    how to set consistent limits? A lot of parents have difficulty with that.
    And in terms of screening, we don’t just screen the individual child but
    also for the child caregiver
-   I agree totally with the relationship screen and family system, its very
    relevant how many stressors there are in the family, cumulative
    stressors . . . back to the Psycho-social Impact of Trauma, medical
    trauma is huge in families with disability, in the whole family system,
    and also that like other cultural issue the cultural issue of disability and
    deaf issues needs to be taken into account, and the culturally
    underserved or inappropriately served are huge issues. They’re not
    going to go for services, or they’re not going to reveal need, because of
    fear of family being broken up.
-   4. The way in which behaviors are dealt with are not consistent in that
    one student, an African American boy, might commit an act and the
    book is thrown at him, whereas another child, a white child, commits
    similar or more severe act and the discipline that’s dealt him is totally
    different. So I think to a large degree I don’t know if training is the
    word, but some sort of intervention for the power structure, the adults
    that are at the school dealing with the kids, because often times the
    way the classroom or school climate is set up is traumatic for the kids,
    and that goes by the wayside, because we have complexities when it
    comes to discipline, when it comes to teachers, what have you,
    whereas its easier to say “it’s the child” as opposed to the behavior and
    it comes to specific children, and the level of services given to the child
    is different in a lot of situations. That’s one of the areas of need, often
    times it’s difficult to sit in the room where the child that’s being
    discussed doesn’t look anything like the people discussing them, and to
    be the only person to bring that perspective it’s difficult and how that
    plays out, and the cost of me doing that. Also when you sit in the
    room for IEP and SET’s the same thing happens, when you have all
    the people on one side and the parents on the other side, are you
    building a community when you set up a meeting that way or don’t
    explain terms in a way parents can understand it? Part of what the
    frustration is resources, to be able to provide services to all the
-   Berkeley is very diverse in terms of “it’s amazing, you cross one street
    and it’s a whole new world”, but a strategy would be some kind of
    equalizer, PEI across the board, school is an equalizer, even the home
    container, if there can be a series that is again, marketing to just the
    need of the child and the youth. I think that the downside is that in
    Berkeley, services around being impoverished or in need or on
    MediCal, we see a lot of the same issues, just more sophisticated in
    terms of the way they look. So around Stigma and Discrimination
    would be to market not just to those who are (you mean to the whole
    community?) yes exactly (whole child?) yes, whether that be a school
    equalizer that joins the disparities together, that would be embraced in
-   3. Studies talk about in state subsidized pre-k the rate of expulsion is
    3X all of k-12. Mediators looking at how teachers feel supported to
    deal with challenging behavior and, many come from ethnic diverse
    language backgrounds and are low paid and many staff seeing in
    children their own life stories and 2. played out, and dealing with
    difficult behaviors. Also when someone says they see African
    American boys are treated differently, for me that means there is some
    need for cultural competency. Cultural differences and the need to
    support them are not understood and there’s no accountability for
    them to understand that, teachers and also mental health services to
    family, so how do you support that?
-   Develop materials that do NOT profile the differences of low-income
-   Support programs that are, that target all children, so let’s put that out
    of the negative and put it in the positive, in Berkeley especially, needs
    programs that targets all children, as a board member I say amen to
    that, because that’s what we’re trying to do, we want all of our schools
    and all of our classrooms to be diverse you have to target the whole
    school, the whole child and all children
-   Homeless people stay in a city for 30 days and then they’re gone, if
    you don’t look at the word “time” you’re missing them. We have all
    kinds of timelines that homeless lose out on, because they didn’t get
    here in October, so schools if there are healthy mental health places
    you can show up any time. If you have a timeline you’re

-   (What does this “whole children, all children” look like?)
-   Important to put out word resiliency and wellness and health
    promotion education
-   One of the things we’ve started doing is focusing on particular skills so
    we’ve started doing life skills assemblies; focus on respect, empathy
    kindness, those sort of things, so we’re addressing things we want,
    we’re giving the expectations of what these things look like and what
    we want to the kids to be showing up as opposed to just focused on the
    negative behaviors and dealing with them from that aspect. That’s one
    of the ways, we’re focusing on all the kids in the school: those who do
    it well end up feeling good and those who don’t can get the model
-   Adequately funded so administrators would embrace it, and have
    services available as needed, without 20 page ridiculous eligibility
-   When I think of resiliency there are intervention styles that can be
    adapted to and taught to whole community. Dialectical therapy
    teaches self-soothing activities, how do you deal with things that are
    hard, how do you cope with them? Talk to teachers, invite parents,
    grandparents, church community Everyone
-   Dreaming about child wellness center that, where anyone can access
    something, it also holds the community, holds needs of children and
    community as a whole, has prevention, generates information,
    advocacy, for families with young children about what their needs are
    and keep changing the system to meet their needs and a training center
    that . . .
-   Language is so important, wellness and resilience, then high needs and
    high risk program, since most of them are overly education
    impoverished or don’t, marketing, we don’t just hit a church and a
    center, we hit everything, schools, workforces, that’s how you get
    participations and outcomes goals, schools goals, leaders, very
-   Engagement

-   Yes engagement (many languages? or language of mental health?)
    being specific about language used to support your work
-   In terms of training, it’s very important that all teachers have the same
    training, cause kids can be in one class and treated different in place to
    place sometimes you can’t change the heart of the teacher, but she has
    to have a response that “this behavior = that response, and this is how
    we deal with it everyone all the time, in all schools”
-   How do we support teachers when there are crises that happen in their
    classroom? At our center there’s been many times when teachers come
    in to sit down and talk about what’s happened and they break down.
    There’s not a lot of support for that, how to deal with what they’re
    dealing with, and they’re dealing with a kid who acts out and that
    behavior is towards the teacher. How do we deal with that? How do
    we deal with a support system for them, because if we’re not dealing
    with that, then the child bears the brunt
-   Secondary trauma
-   More parenting support across regardless of income, having any of the
    services happen in a variety of setting so that people around the city
    have access to it, multiple entry points, big public community Events,
    include mental health support in those places,
-   I love these broad ideas, but my cynical self say 300K and there are so
    many serious incidents, but you talked about the center for early
    childhood consultation, stress relief for teachers is integral for that, so
    if you’re using it on the k-12 level it should be integral, the parallel
    process idea
-   Whatever EI you put in place psycho-social issues are undergirding
    everything – housing costs, pay, hunger, what we call low-income,
    move the bar up, in the end only the wealthy remain, it doesn’t matter
    what you do, if you don’t address these issues families will continue to
    be under tremendous stress.