Jacksonville Coalition for Prevention

Recommendations from the Program Planning and Development Committee on the
Strategy for Preventing and Reducing Youth Violence and Substance Abuse in the Focus Communities in zipcodes 32206, 32208 and 32209 

Purpose of the Committee  The Program Planning and Development Committee was formed in December after the coalition developed the initial draft of the strategic plan.  The role of the committee was to review programs and services and make a recommendation to the larger coalition on the following objectives: 

Objective 1b:To develop a strategy and methods, based on the assessment, to reduce the severity and incidence of existing barriers (that may include methods such as mobile outreach services to families, improved transportation for clients, and reducing the stigma attached to mental health/substance abuse services. 

Objective 4a: To evaluate the model programs researched by project staff and to select one or more promising models on which to focus in the projects to be funded through this strategy. 

Objective 7a: To research model programs and identify one or more that hold promise for adaptation to provide effective opportunities for early screening and identification in the target area and that address issues of concern such as:

      1.   The dirth of locations and/or designated agencies within the target area offering effective early screening and identification;
2.      The need for awareness training on how to spot signs of MH/SA problems and to make appropriate referrals, for professionals such as pediatricians, nurses, and teachers who provide other kinds of services to potentially at-risk children and youth; and
3.      The need for service-system planning to ensure that early screening and identification of MH/SA problems are firmly imbedded in wrap-around and case management approaches to service delivery being used;
4.      With consideration of the “Teen Screen” program as one possible model program 

Overview of the Process

The Program Planning and Evaluation Committee met 13 times between  March and September 2002 with anywhere from 5-20 people in attendance.  The committee had presentations on over 14 programs and services that were recommended either through staff research or committee members. Presentations were made by JCP project staff or by the program staff in the agencies which implement the programs in the community. Listed below are the programs that were reviewed: 

      1.     The Primary Mental Health Project
2.      Effective Black Parenting
3.      African-Centered Behavioral Change Model
4.      Skills for Managing Anger
5.   Columbia Teen Screen
6.      Promoting Alternative Thinking Strategies (PATHS)
7.      I Can Problem Solve: An Interpersonal Cognitive Problem-Solving Program
8.      The Problem of Suicide and Effective Suicide Prevention Programs and Youth
              Suicide Prevention Gatekeeper Training
9.  Challenge Day Program
10. Anger Management and Mental Health Curriculum of the Duval County
              Public Schools
11. Breaking the Silence Program
12. Program Proposal to Educate Youth on Mental Health through Drama
13. Second Step Violence Prevention Program
14. Youth Information Kit – Mood Disorders Association of Ontario 

The Strategy

A continuum of community-based mental health and substance abuse education, screening and treatment services will be developed utilizing existing agencies and organizations. 

In the education component, youth will develop a series of videos to decrease the stigma of  addiction and mental illness. This information will be applied through a local version of the Challenge Day program, where youth will get together for a one-day program where they will break down the barriers that allow violence to continue and grow on school campuses and in the community. This will be complimented by education in the community through the implementation of Breaking the Silence and current education on substance abuse already being implemented through the Health Education Curriculum and community agencies (Gateway Community Services, River Region Human Services, and others). Adults who work with youth will be educated on a problem related to both suicide and substance abuse yet is virtually unspoken: Suicide. Pam Harrington will provide workshops on the Youth Suicide Gatekeeper Training curriculum to pastors, law enforcement, counselors, teachers, youth leaders, after-school staff and other professionals working with youth in the focus communities. Finally, increased community awareness of mental health and substance abuse will decrease the stigma and help increase the rate of parental acceptance of assistance in the Columbia TeensScreen. 

In the screening, referral and treatment component, youth will be screened for mental illness and substance abuse through the Columbia TeenScreen. The coalition will work with the Full Service Schools and other providers to implement the program of screening and referrals in middle and high schools in the focus communities over a multi-year period. Finally, Wraparound Services for students who are referred for treatment of mental health and substance abuse disorders are critical for a significant number of students. The survey of residents in the focus communities showed that transportation and lack of knowledge of community resources were in the top 5 key factors preventing people from accessing services. The studies of the risk factors for youth violence and substance abuse  indicate that many families have a series of issues that must be worked on simultaneously with the mental health and substance abuse: stable housing, employment, domestic violence, parenting, and others. A stable and supportive family is important for the long-term recovery of youth from substance abuse and mental health disorders.  

The Education Component: The Details Youth Video Education Project

Youth will be organized at local private and public schools to develop a number of videos on mental health, substance abuse, violence, suicide, and test anxiety. Existing drama clubs and other in-house school programs for production will be explored to maximize the success of the project. Coordination and video content, revisions, etc. of the video project could possibly be done through each school’s health advisors and make the production of the video a contest in which the students could compete for a “prize” of some sort.  The health advisors would suggest an idea, and the kids would research that idea.  One possible idea suggested was stress management and/or test anxiety level over the FCAT tests.  The principals and significant donators would buy-into this idea because of the present media attention of the FCAT test and the falling scores of a number of schools in the focus communities. Once a video is completed, a “World Premier” could be held in the community for residents. They would be able to see the accomplishment of the youth involved and increase their knowledge of mental health and other issues. If schools are not the best facility for implementing the project, youth groups in churches and after school programs will be approached with this project.

Breaking the Silence:
This is a classroom-based program to educate children in grades 4-12 about mental illness and replace stigma with compassion.  There is a separate set of scripted lesson plans for each grade area (upper elementary, middle school and high school) that include Reading, Discussion, Points to Make and Follow-Up Activities (role play, debate, letter to the editor, etc.) to apply what the student has learned.  There are self-tests, puzzles, games and other items to increase student interest in the materials.  The core NAMI message is an integral part of each lesson: 1) Biology, not a character flaw, causes illness; 2) Mental illness has never been more treatable; 3) Identify the warning signs of mental illness; and 4) Fight the stigma that surrounds mental illness.  Each grade level curriculum packet includes a follow-up questionnaire for the teacher that asks them to provide information on the materials used and the effectiveness and usefulness of them.  Plans can be used for one day or extended to several days.  Curriculum requires no prior knowledge of mental illness. 

Florida Youth Suicide Prevention Gatekeeper Training

The gatekeeper training curriculum was prepared by Pam Harrington in conjunction with the 1999 Youth Suicide Prevention Study. The study showed that suicide is the third leading cause of death for Florida’s 15-24 year olds. A 1997 study by the CDC showed that 1 in 5 high school students seriously considered suicide and most had a suicide plan. The suicide rate has been increasing most rapidly among African-American males 10-19, more than doubling from 2.9 per 100,000 in 1981 to 6.1 per 100,000 in 1998. It will provide evidence-based training to caregivers and gatekeepers to help assure that someone is always there to help. The training consists of 11 modules done in a total of one, two, four or eight hour workshop sessions beginning with how preconceived attitudes and beliefs can hinder the ability to successfully address the sensitive issue of youth suicide and ending with helping survivors and responsible media guidelines. Gatekeepers are natural community helpers who come in contact with youth in schools (teachers, counselors and coaches) and in the community (pediatricians, clergy, police and recreation staff). As a result, they are often in a position to be among the first to detect signs of suicidal ideation and offer assistance to youth in need. 

Challenge Day
Challenge Day is designed to help stop the violence and alienation that youth face every day. A group of students are organized at a middle or high school and trained to facilitate the program. The program consists of a one day challenge at school. A group of 50 or so students from different cliques and groups come together for a day of games, activities, group discussions, icebreakers and trust-building exercises implemented to break down the wall of separation and create new levels of respect and communication with their peers, teachers and the community. Since the program is owned by Challenge Day and costs over $5,000 for the organizations staff to come to Jacksonville and put on the program, the committee would like to see residents trained in the program and develop our own program for the schools in the focus communities.

The Screening, Referral and Treatment Component: The Details 

Columbia TeenScreen: The Columbia TeenScreen Program will be implemented in conjunction with local service providers such as the Full Service schools to identify and refer youth with substance abuse and mental health problems. It was developed approximately ten years ago to screen large numbers of teenagers to identify youth at risk for suicide and/or suffering from undiagnosed mental illness.  The emphasis of this program has been to ensure that youth are not only identified, but also referred for further evaluation and treatment when necessary.  A five-stage process is used to identify youth at risk: 1) Parental consent, 2) written self-report questionnaire, 3) self-administered interview on the computerized voice version of the Diagnostic Interview Schedule (Voice DISC), 4) Review of the DISC information by a mental health professional and a brief interview for students who showed evidence of psychpathology or suicide risk in step three. 5) A case manager ensures that parents are informed about the clinical opinion and students are referred to a local mental health professional for further evaluation and/or treatment. Ongoing case management assures that the youth receives the needed services. The program has been rigorously researched and evaluated for 10 years at Columbia University and is being utilized in test sites all over the country. 

The coalition has discussed different methods of implementing the program here in Jacksonville.  The key issue is that with limited funding, we could not provide services to every child who is screened for needing mental health and other services.  They concluded that the best method might be a two‑part pilot:  A study of the incidence of youth mental health, suicide, and substance abuse  issues in an area high school.  Students exhibiting signs of life-threatening behaviors would be provided assistance immediately however. Another pilot would be small scale pilot implementation of the TeenScreen program in another area school to measure the services needed and the resources utilized in the program. l release.  This two‑pronged approach would give us data on the service needs of youth in Jacksonville, which would be used to make a stronger case for increased funding for mental health and substance abuse services from the state legislature.  The pilot implementation would provide information on what works and does not work, information crucial to the success of the full implementation of the program in Jacksonville. 

Wraparound Program:
Many of the students who will be screened through the TeenScreen and need assistance will need this type of service to ensure admission to, and success in, mental health and substance abuse treatment afterward. In the wraparound model utilized by the Youth Advocate Program and the Community Partnership for the Protection of Children, there are a number of key components utilized: 1) Individualized Service Planning, 2) Community-Based Care, 3) Child/Family Team and 4) Discharge Planning. The Youth Advocate Program will provide case managers to help families access needed services such as employment, child care, respite, substance abuse treatment, mental health treatment, domestic violence services, mentoring, after school programs and others. Services will be provided through community service providers to 30 youth and their families at two schools in the focus communities during 2002/2003. The students will not have entered the juvenile justice system upon entrance to the program. The pilot will tell us how effective wraparound services are at helping youth and their families access and stay in needed mental health and substance abuse treatment services and at preventing a youth’s entrance into the juvenile justice system.