1. Campaign Steering Committee Friday, November 30, 2007 10-1 pm Roseville

2. Welcome & thank you Consumer Voice Public Comment Campaign Steering Roster –Updates to approve Prevention Updates –Where we are –Guiding Principles –Prevention reminders Agenda

3. Recommendations –Priority populations identified Recommendations –Allocation framework by focus –Workgroups Public comment review Wrap-up/next steps Agenda (continued)

4. . VOICE

5. Public Comment Comments Welcome 3-minutes per comment

6. Steering Committee Roster: Request for Approval Consumer youth –Sam Stodolski Need 1 more consumer –Latino, jail, Tahoe Latino, Youth advocate, Tahoe –Emilio Vaca

7. Prevention Planning Review

8. PEI Planning Elements for Discussion Review decision making process –Role of Steering Affirm guiding principles Approve initial priority populations and community needs –Review process first Formalize work groups Approve allocation/funding framework

9. Planning Process Steering Community (Tahoe, Auburn, Lincoln, Roseville) Needs & Assets Steering Establish work groups, approve initial criteria & plan County staff Finalizes decisions Creates work plans Latino Leadership Native American Data collection/Risk & Protective Factors Workgroup #1 Workgroup #2 Workgroup #3 Latino Workgroup Native American Target needs and priorities Steering Reviews workgroup recs,formalizes recs. Recommending Body Decision-making Recommending Body

10. PEI Guiding Principles Cultural competence Collaboration Client / Family centered Recovery /strength- based wellness focus Co-occurring competent Early intervention Evidence based outcome focus Integrated services Accessibility Affirm

11. Prevention Refresher Definition of prevention Trajectories Upstream emphasis “An ounce of prevention is worth of pound of service” -Anonymous Review handout

12. Prevention Interventions that occur before the onset of a problem Can also mean interventions that prevent relapse, disability and the consequences of severe mental illness The Institute of Medicine restricts the definition to processes that occur before there is a diagnosable mental illness.

13. Examples of Protective Factors Family Health care Culture Religion Friends Restricted access to lethal means (suicide) Self-help skills Anger management skills Work/volunteering

14. Examples of Risk Factors Job loss Lack of health care Trauma Physical illness Alcohol/substance abuse Gay youth Native American youth Previous suicide attempt Grils & young women Isolated elderly Discrimination

15. Classification of Prevention Interventions A universal preventive intervention is applicable or useful for everyone in the general population. A selective preventive intervention is targeted at individuals or subgroups whose risk of developing mental health problems is significantly higher than average.

16. Classification of Prevention Interventions An indicated preventive intervention is aimed at individuals who have some symptoms of mental health problems but whose symptoms are not yet severe or prolonged enough to meet diagnostic criteria.

18. Why Intervene Early?

19. Behavior problems in early elementary school predict the initiation of alcohol use as will as greater escalations of alcohol use over time. Children in the first grade with the combination of hyperactivity and social problem-solving deficits have a greatly increased rate of drug and alcohol use when they are between 11 and 12 years old.

20. Why Intervene Early? Children in first grade with behavior problems, anxiety or depression, ADHD have twice the risk of first tobacco use during 4 th through 7 th grade than do children without these early emotional problems. Social competence problems in early childhood is a critical predictor for later substance abuse problems.

21. Why Intervene Early? Children who lack prosocial behavior skills are likely to be rejected by peers and to gravitate toward other rejected children. These socially isolated peer groups, in turn, promote substance abuse and involvement in illegal activities.

22. Why Intervene Early? Early Intervention efforts have demonstrated effectiveness in contributing to the overall mental well- being of children as well as in reducing delinquency, substance abuse, health- risking sexual behaviors and school failure.

23. Step 1: Identifying Needs Who is at risk & for what Steering and Community Input sessions

24. What did you tell us? Steering: Who is at risk & for what: –Children & youth at-risk Poverty, uninsured, abuse, depressed, disabled, poor school performers, substance abuse, incarcerated –Adults Trauma, depressed, single (divorced,widowed,separat ed) –Seniors Depression, drug abuse

25. Community Input Summary (Kings Beach, Lincoln, Auburn)) Children –Neglect, lack of care & security –Those with mentally ill parents and/or substance abuse Youth –Antisocial/isolation, inverted family structure,drugs, neglect, gangs,aggressive LGBT –Transitioning, lack of job skills –Incarceration Who is at risk & for what:

26. Community Input Summary (Kings Beach, Lincoln, Auburn)) Adults - Women (depression, poverty, transp.) –Men (money, jobless, discrimination) Families –Drugs, abuse,early sex, bullying,domestic violence, divorce Seniors –Isolated, depressed –Elder abuse, substance abuse –Health Who is at risk & for what:

27. Latino Leadership Input Children –School failure, domestic violence Women, men & family –Substance abuse, isolation/depression, fear of immigration, lack of medical care, incarceration, job loss Who is at risk & for what:

28. Native Network Input All ages/gender at-risk Family-centered, community approaches –Preservation of cultural knowledge and traditional health practices is top priority. At-risk for: –Historical trauma, discrimination, poverty, homelessness,low educational attainment, lack of access to care “Culture is Prevention” Who is at risk & for what:

29. Summary of Community Needs Depression across all ages groups –Children, youth, adults, seniors, homeless At-risk children and youth –School failure –Juvenile delinquency –Stressed families Underserved cultures –Access to care –Stigma/discrimination

30. What is the Data Telling Us? Refer to handout

31. The Good News: Protective Factors High educational levels –68% some college or higher Low violent crime High graduation rates –91% High Quality Health Care –Low rate of uninsured (3.5% kids) Low unemployment Low poverty

32. Our Risk Factors Population growth 2nd highest in CA –Eldery –Latino Above average suicide rates –34 per 100,000 for (80- 84yrs.) –76% of all suicides are male –25% of all suicides ages 40- 50 –Adolescents on par with State

33. Our Risk Factors Above average rate of child abuse calls –20% Latino substantiated cases Above average alcohol and drug abuse –Hospital discharges 2nd to worst in State –Juvenile arrests –Adult arrests (DUI, other alcohol) –Accidents –25% more liquor stores 100% youth in Tahoe request information on depression

34. Our Risk Factors Pockets of poverty –8 schools have 65% or more free/reduced lunch programs –6 areas identified: North Auburn Lincoln Colfax Central Roseville Foresthill Kings Beach Poverty increases risk of mental illness by 2x in Placer (see handout)

35. Most effective use of $ The more upstream the more effective Shotgun approach will not work –Not a lot of $’s Need to focus

36. Most critical areas to choose: Disparities in Access Psycho-social impact of trauma At-risk children, youth and young adult Stigma & Discrimination Suicide Risk Trauma exposed individuals First onset Children, youth stressed families Children, youth school failure Children, youth juvenile justice Community NeedsPriority Populations Agreement/Approval

37. Proposed General Funding Framework 0-25 yrs. Disparities in Access –Underserved cultures Depression/suicide Discussion Agreement/Approval

38. Recommended Workgroups Children/ Youth At- Risk Depression Suicide Latino Native American Tahoe Focus Areas Disparities in Access Discussion Agreement/Approval

39. Group Work by Jan 25 Provide Recommendations Who is the target? What are the outcomes? Recommendation on prevention strategy: –Universal, selective, etc. Staff will assist

40. Public Comment Review Recap of public comment process Discussion

41. Public Comment Process Written: Letter Staff Responds Steering Reviews 2 weeks Edits/ Final Response Recommended Oral process: Public Comment Steering Listens No formal Response Discussion Agreement/Approval

42. Next Steps Complete community meetings Workgroups meet with staff assistance –Present targets and outcomes Next Steering Meeting Jan. 25 –10-1pm CDRA, Auburn Happy New Year!

43. End