Family & Youth Stakeholder Report on Mental Health Services Act

Family & Youth Roundtable Created By: Family & YouthMHSA-PEI Focus Groups Final Report February 2008Funded by County of San Diego Children’s Mental Health Services

Family & Youth Roundtable – MHSA PEI Family & Youth Focus Group Combined ReportFor the purpose of hosting Family and Youth Mental Health Services Act (Proposition 63) Prevention andEarly Intervention Community Focus Groups, the Family & Youth Roundtable planned outreach effortsand engaged the community along with the following partners: 1. County of San Diego Mental Health staff and their consultant(s) 2. A representative from Partners in Care (Transitional Age Youth, Adult /Older Adult Mental Health Liaison) 3. Members of the Roundtable’s Family & Youth Council 4. Community Organizations that focus on specialty populations identified in the state gap analysis, San Diego priority populations, and San Diego County regional areas : Lesbian, Gay, Bisexual, Transgender and Questioning (LGBTQ) Native American National Alliance on Mental Illness (NAMI) North Coastal League of Women Voters Faith Based Domestic Violence High Schools Immigrants Asian and Pacific Islanders African Americans Latinos Children’s Mental Health Outpatient clinics The Roundtable was successful in hosting nine (9) focus groups. 1. Community Center for LGBTQ Youth in Central Region of County, zip code: 92101 Facilitators: Holly Jones and Ryan Messel 2. Spanish Speaking Parents of youth receiving outpatient mental health services, in North Inland Region of County, zip code: 92125. Two of the groups’ participants reside in Oceanside , in the North Coastal Region . Facilitators: Sonia Curtis and Sharon Morrison Velasco 3. A Domestic Violence Male Perpetrator Group In the Central Region of the County, zip code: 92103 Facilitators: Emily Gillen and Holly Jones 4. A Domestic Violence Female Perpetrators Group in the Central Region of the County, zip code: 92103 Facilitators: Emily Gillen and Holly Jones 5. A Domestic Violence Victims Group in the East Region of the County, zip code: 92020 Facilitators: Debbie Comstock and Cyndi Fuller 6. A Teen Parents/Pregnancy Group in the North Central Region of the County, zip code: 92110 Facilitators: Holly Jones and Donna Ewing Marto 7. A Family Group in the Southeast Region of the County, zip code: 91945 Facilitators: Carlos Millsap and Jean Millsap 8. A Teen (homeless due to Domestic Violence issues) Group in Southbay Region of the County, zip code: 91911 Facilitators: Ryan Messel and Donna Ewing MartoCounty of San Diego Children’s Mental Health Family & Youth Liaison – 12/2008 Page 2 of 12

Family & Youth Roundtable – MHSA PEI Family & Youth Focus Group Combined Report 9. An Asian/Pacific Islander Parent Group of non recipients of Community Mental Health Services in a faith-based setting in the North Central Region of the County, zip code: 92126 Facilitators: Vicky Pantos and Donna Ewing MartoThe Roundtable was unsuccessful in hosting a focus group in North Coastal Region of the County.Attempts were made via: Clinic in Oceanside – “not enough time” to get a group of family/youth together. NAMI North Coastal and League of Women Voters representatives were unable to get groups from this area together for a focus group. (Child representatives seem to be the largest barrier)County of San Diego Children’s Mental Health Family & Youth Liaison – 12/2008 Page 3 of 12

Family & Youth Roundtable – MHSA PEI Family & Youth Focus Group Combined ReportPARTICIPANTS The Roundtable hosted 70 participantsAGE REPRESENTATION:32 Youth, 38 Parents (biological)MILITARY FAMILIES5 of the 70 participants identified themselves as a part of a military familyCounty of San Diego Children’s Mental Health Family & Youth Liaison – 12/2008 Page 4 of 12

Family & Youth Roundtable – MHSA PEI Family & Youth Focus Group Combined Report ETHNIC BACKGROUND Participants Self Identified as follows: 5 unanswered - 1 African -2 African American -10 Black -1 American Indian - 1 Black Hispanic 2 Cambodian - 4 Chamorro - 3 Filipino - 19 Hispanic -2 Latino - 3 Mixed - 2 Native American 1 Samoan - 1 Korean - 13 White ETHNIC BACKGROUND OF FOCUS GROUP PARTICIPANTSCounty of San Diego Children’s Mental Health Family & Youth Liaison – 12/2008 Page 5 of 12

Family & Youth Roundtable – MHSA PEI Family & Youth Focus Group Combined ReportFOCUS GROUPSEach focus group offered translation services when requested. Interpreter services for Spanish,Chamorro and Tagalog where utilized by facilitators. Refreshments were offered at each group as well asdaycare and transportation reimbursement. All participants were given the Roundtable Family Guide tothe Mental Health Services Act. An overview of the MHSA was given to participants verbally as well ascopies of and an overview of San Diego County’s identified priority focus areas.All facilitators received training and facilitator instruction packets from the Family & Youth Roundtablethe training topics included: Family & Youth Roundtable Focus Group Protocol, Guide to the MHSA, SanDiego Community priority focus areas, Reporting requirements, Instructions for participantreimbursementsAll participants will be mailed a copy of this final report on March 11, 2008 with a thank you card fromthe County of San Diego Children’s Mental Health Family & Youth Liaison and an invitation to join theRoundtable’s Family & Youth Council.FOCUS GROUPS IDENTIFIED BARRIERS TO CAREEvery group identified “fear” and/or mistrust of systems (such as: Child Welfare, Educational,Justice) as a barrier to seeking care. o There is apprehension around being labeled at school or in the community as being a cause for isolation and/or stigma o Anxiety of being “reported” to another system and falling into more trouble if they sought help.Dread going to public system offices due to long waits, un-friendliness of staff, judgment, blame andrepetitive paperwork. Note: when groups were asked if any system such as Mental Health wasfriendlier, they did not see any differences in settings (such as Mental Health or Child Welfare);rather they saw all systems as a public system office.A major barrier is protocol. It’s so much useless information; when someone needs help, they needhelp right away.Schools label the kids and they place them in special schools. Schools also tend to stigmatize thekids.All groups identified having a peer as the door opener/guide would ease feelings of mistrust,somewhat. Groups identified peers as someone who has been in trouble before and made it.“A huge barrier in San Diego County is gender. There are no resources for boys/men.”Groups identified lack of community knowledge of resources and how to access services as a barrier,“If I got up the nerve to ask for help, having the door shut in my face because I don’t meet a criteriamakes me not want to seek help.”Youth identified school as a cause for continued stress, teachers/counselors don’t care orunderstand why I do what I do or why I need special help. They just want me out of their class orschool. This statement seemed to be echoed by many youth in the focus groups.“Have places in different areas and engage the people of that area to attend accordingly e.g. InHillcrest you would want to try to engage the LGBTQ population; whereas, in Chula Vista you mightwant to try to engage the Latino population.”“I think the major barrier is that when we go to ask for help, the person is either way older, or forexample, if you’re gay, they send you to an old straight man.”County of San Diego Children’s Mental Health Family & Youth Liaison – 12/2008 Page 6 of 12

Family & Youth Roundtable – MHSA PEI Family & Youth Focus Group Combined Report Youth also expressed that other school stressors are fellow students and school staff lack of understanding or knowledge of their needs. A significant note is that each ethnic population identified their ethnicity as being the least valued by schools and other public systems. Groups felt that currently there are not PEI services offered for anyone, as you have to “get into trouble” before you might get someone to help. “There are a lot of barriers for Mexicans; we can’t get jobs or anything because they don’t have passports.” Transportation and time for parents can be barriers for getting therapy for their children. “People take one person’s actions and then place those actions on that person’s race as a whole.” “It seems like the needier you are, the less services there are in place for you.” There is stigma when a man asks for help (especially mentioned for the police and probation systems). If you have kids and ask for help your kids can be taken away. There are no shelters for men with children, or for families with male children over 12 There are no shelters for families with children in trouble with the law or that have behavior problems “They didn’t know what to do with someone like me. I was shooting up Crystal [Meth] and doing Coke. They wanted me out of that school, whether it be sending me to a hospital, or whatever other means necessary, they just wanted me out.” “What works are Youth Centers and drop-in centers.” “Youth centers are great; put more funding into social event type things.” “We should put more money into advertising. We could put advertisements on buses, so that the youth who take the buses could see the ads and get the help they need.” I don’t know what a behavior problem in my child might look like I only have one child. Afraid of being labeled. Even though there are promises of privacy, people were afraid a diagnosis would affect job opportunities. They were worried about the label following them everywhere. “They tell us to go to your teacher or principal. But when we do, they don’t know how to help us.” “When you have anxiety & these other problems, you build up enough courage just to go. Then you’re made to wait and it just doesn’t work. For someone who barely mustered up enough courage to go in the first place, they’re going to leave before sitting in a waiting room for hours.” “A major barrier is being judgmental. You can tell/feel the vibe when you go into a new place and people are judging you.” “Remove the fear from the marketing of SED Youth” “More realistic advertisements.”FOCUS GROUP MHSA PEI SERVICES SUGGESTIONS Services offered early in a child’s life, before he/she fails – example given if a three year old is kicked out of school or is hurting animals you know there is something wrong, do something then and help the parents to understand what might be wrong and the work they need to do. “Online counseling chat rooms or ims (Instant Messenging). You tend to be a lot more truthful and feel less judged.” Have more services for pregnant teens right after the baby is born, not someone to report me but someone I can trust and learn from.County of San Diego Children’s Mental Health Family & Youth Liaison – 12/2008 Page 7 of 12

Family & Youth Roundtable – MHSA PEI Family & Youth Focus Group Combined Report“When you go in to get help you have to fill out all this paperwork. There should be somewhere youcan just go and check in with someone (without all the paperwork) for them to just see how you’redoing.”“Events like this. It’s so refreshing to hear that people actually care what we think, and that theyare taking our thoughts and comments into consideration.”“Get a mobile unit; you never know who someone getting help might be acquainted with and how itmight help that person.”“Have something out in the community. We have these workshops, any little thing anywherethat someone already goes to and feels comfortable going to.”“Before giving me medication, interview me and get to know me before giving me 10 differentmedications.”“I think that we need more services that go out to the youth, and that they should definitely beconfidential”  Someone noted: “If someone saw someone else getting help, it would raiseawareness.”“Yoga I felt has really helped me feel grounded and stay with treatment. You can definitelyincorporate mental health with physical wellbeing.”Have more people who actually listen to what we as individuals say.The biggest thing noted from the youth groups was: they all said there is nothing that works whenthe person who is trying to help you does not have the life experience that is the same or similar toyours. They don’t fully understand, they create a prejudice about the person and it is notcomfortable.Have more community based resources.Smaller school campuses where we can get to know our counselor, and we don’t “slip through thecracks”.Have more men available for male teens to talk with and learn from. This was a theme in mostgroups however this was stated strongest by the youth from Domestic Violence homeless teen’sgroup most often.Men stated that there are not enough services for men available.“If there was a spot, at school, where they could go anonymously to get the help they need withoutthe parents involvement.” Someone noted: “Well if the school is mandated to notify the parentsin certain circumstances, then how would the parents not be involved?”“It has to be a comfortable setting; if people don’t feel comfortable at a place, they won’t use it.”“Set up services in the nurse’s office. Because then, once a week, people could go in and get thehelp that they need, without it seeming odd to the other students.”“Have better case managers. What doesn’t work is when everything is written down and it’s allstandard and formulated. You can’t expect the same things to work for different people, in everycircumstance.”“Make it closer; don’t have me go from La Jolla to Bonita to get services.”“An anonymous Peer hotline or a toll-free line that wouldn’t show up as having anything to do withMental Health Labels. Have someone on the line 24/7, never a machine.” “Have someone who hasalready been through the program, someone who has been in your position and can relate to you.”A treatment center for families as a whole – a group that caters to both parents and children as aunit. Right now services seem to support divorce, if you want keep your kids.County of San Diego Children’s Mental Health Family & Youth Liaison – 12/2008 Page 8 of 12

Family & Youth Roundtable – MHSA PEI Family & Youth Focus Group Combined ReportHaving a contact resolution hotline that people can call as an alternative to calling 9-1-1 o Calling the police can escalate a situation o Having a place to go to calm down prevents [escalation] o A mediator or neutral party can prevent [escalation]Concern was voiced that if we include counseling in schools it should not interfere with the school’sability to provide education o If there is to be a counselor in the schools it needs to be a mental health professional not a teacher or guidance counselor wearing many hats o Schools should focus on educationIf a school notices a problem they should report the problem to the proper authorities o There should be goals set together by school authorities and mental health authorities.There should be an alternative program to kicking kids out of school – that just promotes the cyclicalbehavior. We need to get kids help instead of suspending them. Suspensions wind up just being aprelude to getting expelled or dropping out.All programs should be for children AND parents so that they can all come together to prevent afamily breakdown.Some men said that parents should be involved in their children’s treatment and that providersshould involve the parents as much as possible. Others said that sometimes children might not feelas comfortable opening up in front of their parents and maybe they could use the support of a closerelative. Others pointed out that some children don’t even have positively influential relatives andmight want the support of a friend.The Family Group identified that the Parent is the treatment plan, if they are not part of theplanning there is no plan.There was a suggestion to counsel children and parents separately and then bring them together fora joint session.Group counseling could be offered in a setting that made it seem more like a nice dinner or a nightout rather than the formal “counseling” setting.Classes but BEFORE the violence happens.Add relationship and emotional health classes in high schools and junior highs for all students.Continued support after your court ordered support ends.Classes teaching parents how to identify potential problems BUT included what parents can do toprevent the problem.Have providers let parents and children learn to communicate together.It’s a good idea to have independent providers of mental health professionals on school grounds butcounselors should not be school related. o It is also important to keep the sessions separated form school records.Prescription drugs - mental health screeningParent peer support – Note: The woman who made the peer support points was making asuggestion. We mentioned our Family Support Partner Program which just happened to overlap wellwith the suggestions – which all the women were interested in learning more about this programCase managementHave someone to help guide you though the systemSomeone less scary than suit and tieGiving everyone a chance to go to counseling before taking the children, counseling with the child soyou know what’s going on.Need to be educated and most importantly they need to believe it / feel it (to change it) withinthemselves.County of San Diego Children’s Mental Health Family & Youth Liaison – 12/2008 Page 9 of 12

Family & Youth Roundtable – MHSA PEI Family & Youth Focus Group Combined Report Support Group Classes and Focus Groups are important– helps open your eyes to realizing and accepting (and eventually changing) the problem. Everyone needs to hear different perspectives. “I just wouldn’t want to see someone down and out with nowhere to go. Just somewhere you could go and they could help you no matter what.” “I’ve heard other people talk about a service and then I tried to go and get help and they turned me down because I didn’t fit the criteria of why they started that program in the first place.” “They need to have all of the programs intertwined; that way, if you don’t fit the criteria of 1 program, they can refer you to somewhere where you do meet the criteria.” “They need more spots that focus on teenagers and giving them the services they need.” “They need to have teen peer to peer programs in place “They should have more things like this, where they come and talk to you, but in the schools.” “More people who have gone through the same types of things should be the ones who go out and talk to the youth.” “We like having a male counselor because we get to do boys stuff.”DOMESTIC VIOLENCE GROUPS SPECIFIC IDENTIFIED NEEDS The county is lacking in resources for female perpetrator services – Note: Male perpetrators made the same statement about lack of services for them. After being labeled you lose a lot of rights if you are a victim and you don’t leave your husband you can be labeled a perpetrator for: Retaliation, Failure to protect your child. Then once labeled, you lose options for help: You can’t go to a shelter You can’t use services for victims You can’t access family services You can’t go to a homeless shelter There is a mandatory 3 year restraining order It’s “not always useful and causes more problems” “The 52 week class provides support and counseling for one of the three years but what about the next two years?” 100 yards and if your partners comes you have to drop what you are doing and leave You can’t call him but he can call you The women wanted a safe system in place as an option for both sides to agree to lift the restraining order. They should check in three months before the completion of this class and ask what you need for the future.Women wanted commitment of support - even if they go back to their partner. There are no levels of domestic violence; there is one label alone even if it’s just a misdemeanor the title stays and all restrictions apply. There should perhaps be degrees. One catch-all umbrella term doesn’t cover every situation. It is a huge barrier to getting a job which cause more stress and potential for more violence.County of San Diego Children’s Mental Health Family & Youth Liaison – 12/2008 Page 10 of 12

Family & Youth Roundtable – MHSA PEI Family & Youth Focus Group Combined Report There are a lot of misconceptions about female domestic violence offenders. People assume they all used weapons – or are psychotic. It is assumed that they were all victims who retaliated – pity stigma. There are no appropriate DV services, its one size fits all. It’s important that they all are able to see a psychiatrist or someone at low cost / free before: You get convicted, Try to commit suicide or other harmful events happen. To lift the stigma we need to get domestic violence perpetrators out in the open for people to meet; they need their voices heard.The PEI program needs to work with the whole family, children and parents, together so that everyoneis on the same page.BOTH sides of the party need counseling with their kids – like an Alcoholics Anonymous (AA) for familymembers.The partner needs to know what their partner is learning in class. Even if the class attending partner isbringing home examples of what he or she is learning, there is a trust that has been broken andcommunication may not be effective.County of San Diego Children’s Mental Health Family & Youth Liaison – 12/2008 Page 11 of 12

Family & Youth Roundtable – MHSA PEI Family & Youth Focus Group Combined ReportIn a family member Focus Group, two families shared life experiences that demonstrated whatmight be consider successful interventions and failure: A focus group family member participant shared a success story she felt demonstrated successful interventions. Her child attended a charter school and it was small enough setting for the educators, principal and even the gardener to know her child. Her child was labeled ADHD. There were times that the parent was not able to make it to the school to attend to her child on those occasions her child’s school mentors would step in to handle the situation. Her child would work with the gardener once in awhile for an hour to use up physical energy among other benefits this relationship gave way to. The school principal built relationships by playing soccer with children before school. This made the children feel confident and gave them a comfort level with the principal; they knew they could talk to him. Having mentors for the kids that understand their needs is a good preventive measure for mental health. In the same focus group a family member participant shared a not so successful school story that demonstrated needs our educational systems might have before they can provide PEI services. Her child was in 6th grade and bullied by peers. The child’s teacher laughed at the child often because he was different and he had that stigma attached to him. Because of this he had a difficult time learning and feeling comfortable in school. Therefore, this parent pulled her child out of the public school system and he was home schooled for 6th grade; he ultimately dropped out of school. However, he has achieved in getting a GED. This parent feels the 6th grade teacher was tired of dealing with her son and gave up on him. “Educators need to be trained”.County of San Diego Children’s Mental Health Family & Youth Liaison – 12/2008 Page 12 of 12