Behavioral Health Office of Cultural Competence and Ethnic

Behavioral Health Office of Cultural Competence and Ethnic Services Efforts Towards Reducing Health Disparities Imo Momoh, MPA Cultural Competency Officer September 1, 2016 www. SBCounty. gov

Behavioral Health Vision and Mission Page 2 § Behavioral Health Vision, Mission, Service Goal… We envision a County of San Bernardino where all persons have the opportunity to enjoy optimum wellness, whether they have experienced mental illness, substance abuse, or other addictions. The County of San Bernardino Behavioral Health Programs strive to be recognized as a progressive system of seamless, accessible and effective services that promote prevention, intervention, recovery and resiliency for individuals, families and communities. To create a state-of-the-art, culturally competent system that promotes recovery/wellness for adults and older adults with serious mental illness and resilience for children and youth with serious emotional disorders and their families. ” Behavioral Health www. SBCounty. gov

Medi-Cal/Poverty Population Comparison by Race/Ethnicity RACE/ETHNIC GROUP POVERTY POPULATION COUNTY POPULATION AFRICAN AMERICAN/BLACK 9. 9% 8. 5% ASIAN/PACIFIC ISLANDER 5. 4% 6. 3% CAUCASIAN/WHITE 30. 1% 32. 9% LATINO/HISPANIC 51% 49. 6% NATIVE AMERICAN 0. 7% 0. 4% Behavioral Health Page 3 www. SBCounty. gov

Medi-Cal Beneficiaries and Beneficiaries Served by Race/Ethnicity Fiscal Year 15/16 RACE/ETHNIC GROUP TOTAL BENEFICIARIES SERVED AFRICAN AMERICAN/BLACK 10. 9% 17% ASIAN/PACIFIC ISLANDER 4. 8% 2. 2% CAUCASIAN/WHITE 19% 33. 6% LATINO/HISPANIC 56. 1% 38. 8% NATIVE AMERICAN 0. 2% 0. 5% Behavioral Health Page 4 www. SBCounty. gov

Comparison by Region Fiscal Year 15/16 Page 5 San Bernardino County Comparison Demographic Indicators FY 1516: By Region 35. 0% 30. 0% 25. 0% 20. 0% 15. 0% 10. 0% 5. 0% 0. 0% Central Valley Desert/Mountain Population Behavioral Health Poverty Pop East Valley Medi-Cal Benef West Valley Medi-Cal Benef Served www. SBCounty. gov

Comparison by Race/Ethnicity Group Fiscal Year 15/16 Page 6 San Bernardino County Comparison Demographic Indicators FY 1516: By Ethnic Group 60. 0% 50. 0% 40. 0% 30. 0% 20. 0% 10. 0% African Ame. / Black Asian / Pacific Islander Population Behavioral Health Caucasian / White Poverty Pop Latino / Hispanic Medi-Cal Benef Native Ame. Other Ethnicity Medi-Cal Benef Served www. SBCounty. gov

Comparison by Age Group Fiscal Year 15/16 Page 7 San Bernardino County Comparison Demographic Indicators FY 1516: By Age Group 50. 0% 45. 0% 40. 0% 35. 0% 30. 0% 25. 0% 20. 0% 15. 0% 10. 0% 5. 0% 00 -14 years 15 -24 years Population Behavioral Health Poverty Pop 25 -59 years Medi-Cal Benef 60+ years Medi-Cal Benef Served www. SBCounty. gov

Medi-Cal Beneficiaries Change Over Time Page 8 FISCAL YEAR 2010 -2011 -2012 -2013 -2014 -2015 -2016 MEDI-CAL BENEFCIARIES 443, 417 452, 819 444, 710 503, 044 692, 968 772, 550 PERCENTAGE CHANGE OVER TIME 2. 10% -1. 80% 13. 10% 37. 80% 11. 50% Behavioral Health www. SBCounty. gov

Medi-Cal Penetration Rate Change Over Time Page 9 RACE/ETHNIC GROUP FY 10/11 FY 11/12 FY 12/13 FY 13/14 FY 14/15 FY 15/16 AFRICAN AMERICAN/ BLACK 8. 5% 8. 9% 9. 5% 10. 9% 9. 2% 8. 5% ASIAN/PACIFI C ISLANDER 4. 0% 4. 1% 4. 2% 2. 8% 2. 5% CAUCASIAN/ WHITE 11. 5% 11. 8% 12. 7% 14. 7% 11. 3% 9. 6% LATINO/ HISPANIC 3. 9% 4. 1% 4. 5% 4. 9% 4. 1% 3. 8% NATIVE AMERICAN 12% 13. 9% 13. 1% 16. 8% 15. 4% 12. 6% Behavioral Health www. SBCounty. gov

Population Assessment: Examining Barriers that Create Disparities Page 10 § Recent studies conducted locally and statewide focused on examining healthcare disparities. These studies provided valuable information used to improve our current system of care and increase access to mental health services. • Project Access (2009) • California Reducing Disparities Project (2009 -Present) Behavioral Health www. SBCounty. gov

Project Access Page 11 § Project Access was published in October 2009. § The study identified various barriers that prevent the following groups from accessing and utilizing mental health services. • Asian American/Pacific Islander; • African American/Black; • Hispanic/Latino; § Research findings indicate there are barriers at the individual, community, and organizational levels. § A key study component is understanding the difference between utilization of services and accessibility of services. • Both are important in increasing mental health service equity. Behavioral Health www. SBCounty. gov

California Reducing Disparities Project Page 12 § The California Reducing Disparities Project is an ongoing MHSA funded project that began in 2009 focused on the following demographic groups: • • African Americans; Asians and Pacific ; Islanders (API) Latinos; Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning (LGBTQ); • Native American. § Project goals are to identify solutions for historically unserved, underserved, and inappropriately served communities. Behavioral Health www. SBCounty. gov

Interpreting and Applying Study Findings to Our Page 13 System of Care § Project Access § § § Race, ethnicity, gender, and age must be addressed when developing strategies to increase usage of mental health services. Cultural and language specific marketing is important in reducing stigma and addressing specific cultural mental health beliefs. Structural and organizational barriers such as service hours and referral processes contribute to decreased service utilization. § California Reducing Disparities Project § § § Community defined practices and community focused solutions are key to reducing disparities in access and utilization of mental health services. It is important to develop local system approaches to mental health treatment that are safe, welcoming, culturally and linguistically appropriate. Developing culture specific approaches to mental health care is effective in addressing barriers. Behavioral Health www. SBCounty. gov

African American/Black Barriers to Service Page 14 § Stigma; § Language and cultural barriers; § Perception of service/perceived discrimination from service provider; § Overutilization of crisis services; § Lack of African American/Black providers. Behavioral Health www. SBCounty. gov

Asian/Pacific Islander Barriers to Service § § § Page 15 Stigma; Lack of mental health awareness; Language; Lack of disaggregated data; Lack of culturally defined treatment. Behavioral Health www. SBCounty. gov

Hispanic/Latino Barriers to Service § § Page 16 Stigma; Lack of mental health awareness and information; Immigration status; Lack of culturally and linguistically appropriate services; • Lack of skilled bilingual and bicultural staff; § Rigid system of care. Behavioral Health www. SBCounty. gov

Native American Barriers to Service § § § Page 17 Lack of community defined treatment options; Jurisdictional and systemic barriers; Tribal enrollment status; Historical trauma; Loss of culture and cultural identity. Behavioral Health www. SBCounty. gov

DBH Efforts to Reduce Mental Health Disparities Page 18 § DBH has made considerable efforts to enhance our service delivery system with programs, outreach and education that increases accessibility and utilization of mental health services. • Targeted at our overall population and specific cultural/ethnic groups. § These efforts are driven by state and federal legislation. • Affordable Care Act (2010) • Mental Health Services Act (2004) Behavioral Health www. SBCounty. gov

Psychiatric Triage Diversion Program goal is to reduce unnecessary hospitalizations by referring consumers to the appropriate (least restrictive) level of care. Services provided include: § Screening and assessment; § Assistance with placement; § Transportation; § Referrals for outpatient treatment; Behavioral Health Page 19 Barriers Addressed § Overutilization of crisis services and highly restrictive services; § Transportation; § Linkage to services; www. SBCounty. gov

Community Crisis Response Team (CCRT) Program Description and Goals § Reducing unnecessary hospitalizations and arrests/incarceration; § Mobile crisis response; § Partnership with local law enforcement; § Locations throughout the county; § Services available 24/7. Behavioral Health § § Page 20 Barriers Addressed Access to care; Linkage and referral to services; Rigid system of care; Linguistically appropriate services. www. SBCounty. gov

Native American Resource Center (NARC) Program Description and Goals § One stop healthcare center for Native Americans and Alaskan Natives that provides healthcare, mental health, and substance use treatment. § Utilizes community defined practices and cultural approaches to treatment. • White Bison and Sweat Lodges Page 21 Barriers Addressed § Lack of community defined treatment options; § Jurisdictional and systemic barriers; § Tribal enrollment status; • NARC accepts all Native Americans and Alaskan Natives regardless of tribal enrollment status; § Culturally based outreach, education, family support, parenting, and youth empowerment. § Incorporates cultural traditions and § Historical trauma; identity into treatment. § Loss of culture and cultural identity. Behavioral Health www. SBCounty. gov

Promotores de Salud/Community Health Workers Program Description and Goals This program is designed to address the needs of our culturally diverse communities with an overall objective to increase community awareness, connection to community-based prevention and behavioral health services. § Peer support; § Linkage to treatment and services; § Culture specific outreach and engagement; § Culture specific services provided to the following groups: African American/Black, Asian/Pacific Islander, Latino/Hispanic, LGBTQ, and Native American; § Services are provided in the following languages: English, Spanish, Cambodian, Vietnamese, Tagalog, and Korean. Behavioral Health Page 22 Barriers Addressed § Stigma; § Language; § Lack of awareness. www. SBCounty. gov

Family Resource Centers (FRC) Program Goals and Description FRCs offer various programs that are culturally and linguistically competent and meet the identified needs of the communities they serve. Services include: § Prevention and leadership programs for children, youth, and TAY; § Mental health education classes; § Community counseling; § Adult skill based courses and parenting classes; § Overall health and wellness courses. Behavioral Health § § § Page 23 Barriers Addressed Stigma; Community defined treatment options; Accessibility of services; Lack of bilingual and bicultural staff; Rigid system of care. www. SBCounty. gov

Resilience Promotion in African American Children (RPi. AAC) Program Goals and Description RPAAC provides mental health prevention services in culturally appropriate settings incorporating African-American philosophies and traditions and offer mental health education programs that promote resiliency in African American youth. Services are offered at school site locations and focus on the strengths of the African American community. Services offered include: § Mentoring; § Parenting classes; § Conflict resolution; § Referrals and linkage to services; § Skills training to increase protective factors. Behavioral Health § § § Page 24 Barriers Addressed Stigma; Culturally defined treatment and practices; Rigid system of care; Accessibility of services; Lack of African American/Black providers; Culture based outreach. www. SBCounty. gov

Other Programs, Services, and Activities Page 25 § Cultural Competence Advisory Committee (CCAC) • 12 subcommittees that focus on race, ethnicity, gender, etc. § Cultural Competence Trainings • Internal and External § Language Services • Video interpretation • Translation services provided § Field Testing Documents § Culturally and Linguistically Appropriate Materials • All written materials are provided in English and Spanish. • Materials are written in an easily understood format (5 th grade level). Behavioral Health www. SBCounty. gov

Community Outreach and Education Page 26 § DBH offers community education courses designed to increase awareness, address stigma, increase knowledge and understanding of behavioral health. • Mental Health First Aid; • ASIST (Applied Suicide Intervention Skills Training. § DBH also facilitates Crisis Intervention Training for local law enforcement. • 40 hour training; • Teaches officers verbal de-escalation skills, how to interact with persons experiencing a mental health crisis, and local mental health resources. Behavioral Health www. SBCounty. gov

Moving Forward: Goals and Strategies Page 27 The CA Reducing Disparities Report provides several goals and strategies for reducing mental health disparities and barriers to services. Many of the goals are currently implemented. Goal #1 - Increase access to mental health services for unserved, under served and inappropriately served populations. § Strategies; • Create additional opportunities for co-location of services. • Develop resource guides to facilitate service access. • Continue utilizing schools for centers of wellness in the community along with other naturally occurring settings. • Prioritize prison/jail reentry programs. Behavioral Health www. SBCounty. gov

Moving Forward: Goals and Strategies Page 28 Goal #2 - Improve the quality of services for unserved, under served and inappropriately served populations. § Strategies; • Continue developing a culturally and linguistically diverse workforce. • Continue activities that promote linguistic access to services for the diverse county population. • Ensure culturally and linguistically competent services. Behavioral Health www. SBCounty. gov

Moving Forward: Goals and Strategies Page 29 Goal #3 - Build on community strengths to increase the capacity of and empower unserved, under served and inappropriately served communities. § Strategies; • Continue encouraging stakeholder participation in CCAC and subcommittees. • Continue engaging the faith-based community. • Support community involvement and engagement. Behavioral Health www. SBCounty. gov

Moving Forward: Goals and Strategies Page 30 Goal #4 - Develop, fund and demonstrate the effectiveness of population specific and tailored programs. § Strategies; • Establish a network of community health workers and traditional healers. • Fund culturally specific research and develop culturally specific practice models. Behavioral Health www. SBCounty. gov

Moving Forward: Goals and Strategies Page 31 Goal #5 - Develop and institutionalize local and statewide infrastructure to support the reduction of mental health disparities. § Strategies; • Engage the community in the CRDP implementation process. • Collaborate with other county departments and organizations that are committed to reducing disparities. • Develop ongoing community/county partnerships. Behavioral Health www. SBCounty. gov

Conclusion Behavioral Health Page 32 www. SBCounty. gov

Questions Page 33 Questions? Contact Information Imo Momoh Cultural Competency Officer Office of Cultural Competence and Ethnic Services imo. momoh@dbh. sbcounty. gov cultural_competency@dbh. sbcounty. gov Behavioral Health www. SBCounty. gov

References Page 34 • CRDP Fact Sheet • http: //www. cdph. ca. gov/programs/Documents/CRDP_Fact_Sheet_04252014. pdf • CRDP Strategic Plan to Reduce Mental Health Disparities 2014 from the California Pan-Ethnic Health Network • https: //www. cdph. ca. gov/programs/Documents/05_CRDP_Strategic_Plan_OHE-AC_%2005 -14 -Color. pdf • Native Vision Report • https: //issuu. com/nativeamericanhealthcenter/docs/native_vision_report § Project Access 2009 Behavioral Health www. SBCounty. gov