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.
The California Center for Dignity, Social Inclusion & Stigma Elimination
Center Objectives and Core Values
The California Center for Dignity, Social Inclusion & Stigma Elimination
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
The California Center for Dignity, Social Inclusion & Stigma Elimination
Center Core Values
Cultural Competence, Linguistic Diversity and Cultural Effectiveness
Community Expertise Community Empowerment Life at all ages Youth Empowerment.
The California Center for Dignity, Social Inclusion & Stigma Elimination
Center Objectives
The California Center for Dignity, Social Inclusion & Stigma Elimination
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
The California Center for Dignity, Social Inclusion & Stigma Elimination
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
The California Center for Dignity, Social Inclusion & Stigma Elimination
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
The California Center for Dignity, Social Inclusion & Stigma Elimination
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.
The California Center for Dignity, Social Inclusion & Stigma Elimination
Technical Assistance Research and Training Center Model
3 Core Units1. Research/Evaluation2. Training/TA3. Communications & Dissemination
The California Center for Dignity, Social Inclusion & Stigma Elimination
Current Projects
The California Center for Dignity, Social Inclusion & Stigma Elimination
Promoting Efficacy and InnovationEvidence Based Practices
Promising Practices
Best Practices
Emerging Practices
Outc
ome
Eval
uatio
n
The California Center for Dignity, Social Inclusion & Stigma Elimination
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.
The California Center for Dignity, Social Inclusion & Stigma Elimination
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.
The California Center for Dignity, Social Inclusion & Stigma Elimination
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
The California Center for Dignity, Social Inclusion & Stigma Elimination
Promoting Efficacy and InnovationEvidence Based Practices
Promising Practices
Best Practices
Emerging Practices
Outc
ome
Eval
uatio
n
The California Center for Dignity, Social Inclusion & Stigma Elimination
The Challenge: Stigma and Stigma Change
The California Center for Dignity, Social Inclusion & Stigma Elimination
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.
The California Center for Dignity, Social Inclusion & Stigma Elimination
• Public stigma• Self-stigma• Structural stigma• Label avoidance(No treatment =no labels = no shame)
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Varieties of Stigma
The California Center for Dignity, Social Inclusion & Stigma Elimination
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.
The California Center for Dignity, Social Inclusion & Stigma Elimination
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.
The California Center for Dignity, Social Inclusion & Stigma Elimination
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
The California Center for Dignity, Social Inclusion & Stigma Elimination
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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 California Center for Dignity, Social Inclusion & Stigma Elimination
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
The California Center for Dignity, Social Inclusion & Stigma Elimination
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
The California Center for Dignity, Social Inclusion & Stigma Elimination
Stigma Change:What do we know works?
The California Center for Dignity, Social Inclusion & Stigma Elimination
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
The California Center for Dignity, Social Inclusion & Stigma Elimination
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.
The California Center for Dignity, Social Inclusion & Stigma Elimination
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
The California Center for Dignity, Social Inclusion & Stigma Elimination
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
The California Center for Dignity, Social Inclusion & Stigma Elimination
Mean effect by anti-stigma approach: overall attitudes, affect, and behavioral intention
The California Center for Dignity, Social Inclusion & Stigma Elimination
Mean effect sizes by anti-stigma approach – RCTs only: overall, attitudes, and behavioral intention
The California Center for Dignity, Social Inclusion & Stigma Elimination
• 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
The California Center for Dignity, Social Inclusion & Stigma Elimination
Targets• Landlords• Health care professionals• Teachers• Legislators• Employers
The California Center for Dignity, Social Inclusion & Stigma Elimination
How Can the Center help Eliminate Stigma?
The California Center for Dignity, Social Inclusion & Stigma Elimination
Technical Assistance Research and Training Center Model
3 Core Units1. Research/Evaluation2. Training/TA3. Communications & Dissemination
The California Center for Dignity, Social Inclusion & Stigma Elimination
Logic Model
Inputs
Outcomes
The Center for Dignity,
Social Inclusion,
and Stigma Elimination
Sche
dule
Scope
Cost
Project Management Framework
The California Center for Dignity, Social Inclusion & Stigma Elimination
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
The California Center for Dignity, Social Inclusion & Stigma Elimination
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
Training & Technical
Assistance Efforts
Outreach and
Dissemination Team
Training & Technical
Assistance Team
Research and
Evaluation Team
The California Center for Dignity, Social Inclusion & Stigma Elimination
Project Partners An example of the Power of Connection in a time of change
The California Center for Dignity, Social Inclusion & Stigma Elimination
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
The California Center for Dignity, Social Inclusion & Stigma Elimination
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.
Center Project Partners
The California Center for Dignity, Social Inclusion & Stigma Elimination
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.
Center Project Partners
The California Center for Dignity, Social Inclusion & Stigma Elimination
What can we do for you?
The California Center for Dignity, Social Inclusion & Stigma Elimination
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.
The California Center for Dignity, Social Inclusion & Stigma Elimination
Clearinghouse Database Index: Age Ethnicity Language Targeted Goals Type of Stigma Geography Targeted
Community
Approach Venue Medium Other Diversity ?
The California Center for Dignity, Social Inclusion & Stigma Elimination
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
The California Center for Dignity, Social Inclusion & Stigma Elimination
Community Development Partners
Community Investigators
Youth Champions / Young Investigators
Final thoughts – Creating Living Laboratories
The California Center for Dignity, Social Inclusion & Stigma Elimination
Questions? / Thoughts?
The California Center for Dignity, Social Inclusion & Stigma Elimination
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
For more information please contact:
The California Center for Dignity, Social Inclusion & Stigma Elimination
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