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Mental health advocacy and navigation partnerships: the case for a community collaborative approach
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Content
Running head: MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 1
Mental Health Advocacy and Navigation Partnerships:
The case for a community collaborative approach
Daffney Kubler-Hoffman
Doctor of Social Work
University of Southern California
December 2019
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 2
Dedication:
This project is dedicated to my Army brats, Aubree, AJ and Cooper, and all their friends.
Community makes a difference, inclusion counts.
Acknowledgements:
With a ton of gratitude to my loving, “all-in” husband, Allen. I can’t thank you enough for
loving me and supporting me that way you do (and footing the bill). Here’s to a lifetime of being
stuck together. There is no way to thank a woman who takes care of your children with the love
you would have. My mom, Cookie, is simply the best mother in the whole world. She
epitomizes the goal of ensuring your children have more than you had; your sacrifices are not
unnoticed. I also want to give thanks to the family, friends, and co-workers who supported me
and my work in this labor of love.
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 3
Executive Summary
The process of designing an innovative solution to a wicked social problem is complex;
thus, the capstone project was a non-linear process. The capstone was initially designed from a
space of working on the Grand Challenge to Ensure Healthy Development for All Youth, which
focuses on the importance of promoting and implementing a prevention-based approach to
promote better youth mental health outcomes (Fong, Lubben, & Barth, 2018, p. 19-24). The
intent was to target adult caregivers of youth for intervention to promote decision making that
includes help-seeking and encouraging resource engagement with early signs of mental distress
or behavior disturbance. This early intervention is important as 50% of all mental illness starts by
age 14 and 75% by age 24 and there is an average 8-10 year gap between the onset of mental-
behavioral health symptoms of youth and the first episode of treatment ("Mental Health By the
Numbers," n.d.).
Through the process of designing, innovating, and gathering stakeholder feedback, it
became clear that, before we can get a foothold on youth mental health and well-being via health
promotion activities, we must first address the issue of mental health stigma as a systemic issue
that fundamentally affects how, when, and where people interact with programs and systems
designed to alleviate these issues. While the mechanism is unclear in the literature and still an
area of research, it appears that stigma creates a barrier to discussion and early help-seeking
behavior. The Grand Challenge to Achieve Equal Opportunity and Justice focuses on addressing
and alleviating inequality associated with social stigmas, one of which is related to mental health
stigma (Fong, Lubben, & Barth, 2018, p. 248-260). Stigma affects opportunities available to
people, particularly concerning health outcomes, housing, academic achievement, income, and
involvement with law enforcement.
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 4
Military children and adolescents are a subset of the American youth population with a
unique set of stressors that deserves the full attention of resources dedicated to improving mental
health outcomes. Beliefs regarding personal fortitude and bootstrap mentalities may unduly
impact military-affiliated youth and their families. Stigma serves as a barrier to youth and
families accessing treatment for child and adolescent mental illness and behavioral problems.
The innovation is designed to disrupt the social norm of waiting until there is a crisis to engage
in help-seeking behavior and accessing care for youth by education and empowering caregivers
to act sooner rather than later. By implementing the innovative Mental Health Advocacy and
Navigation Partnerships for Youth programs (community collaboratives), we can begin to disrupt
the deleterious effect of mental health stigma on help-seeking and effective engagement in
available care at the earliest signs of mental or behavioral health concerns for our military-
affiliated youth. The use of neighborhood champions throughout the community and a centrally-
located referral and navigational assistance center has significant potential to reduce stigma and
improve service delivery and utilization by military-affiliated youth and their families.
The project is implementation ready as evidenced by plans to meet with local Army
Community Services leadership via known social network contacts to begin the process of
gaining approval for piloting on the Fort Riley installation. Once the pilot is complete, efforts
should be made to diffuse the innovation across all Army installations and then other Department
of Defense installations before efforts are made to introduce the approach to civilian
communities. Accessing the power of the military community connection has the potential to
genuinely disrupt the status quo and deliver the best to our youth who also serve.
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 5
Conceptual Framework
Statement of the Problem
The Grand Challenge to Achieve Equal Opportunity and Justice champions the need to
confront the ongoing marginalization of numerous groups of individuals in the United States and
the resulting inequity concerning health, education, housing, and employment. Mental health
stigma is a formidable factor that creates a significant barrier to accessing care for mental illness
(Corrigan, 2004; Corrigan & Bink, 2016; Corrigan, Druss, & Perlick, 2014; Corrigan & Al-
Khouja, 2018), thus impacting the quality of life and longevity. The purpose of the capstone
innovation is to disrupt the social norm of avoiding mental health care for children and
adolescents until there is a discernable, often critical need for care through primary prevention
activities by addressing stigma as a “fundamental cause of health inequality” (Goldbach, Amaro,
Vega, & Walter, 2015). Goldbach, Amaro, Vega, and Walter (2015) further assert, in the paper
titled The Grand Challenge of Promoting Equality by Addressing Social Stigma, that a
“reconceptualization of stigma as a fundamental cause of social disadvantage” is an opportunity
to overcome stigma broadly.
Hawkins et al. (2015) penned Unleashing the Power of Prevention to address the missed
opportunity to prevent youth mental illness, and subsequent poor outcomes, by failing to take a
preventative stance regarding mental health and well-being in childhood and adolescence. The
goal of the Grand Challenge to Ensure Healthy Development for All Youth is to decrease the
prevalence of mental illness in youth and decrease racial and socioeconomic disparities amongst
those with mental illness. Parker (2016) shares some reasons for such inequity include lack of
education and misunderstanding about mental health, the role of faith, spirituality, and
community, as well as barriers to access to care. A personal-strengths focus and “bootstrap”
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 6
mentality may compound this issue when considering Active Duty Service Members and their
families. While mental illness is not discriminatory, it is undoubtedly opportunistic. Prevention
efforts will fail if stigma is not addressed as a foundational barrier to awareness of risk and
recognized as a fundamental factor in engaging mental health promotion and prevention
activities by youth and their families.
The capstone innovation is designed to address mental health stigma in military-affiliated
children and adolescents through joint caregiver and community engagement efforts. The project
is at the nexus of the Grand Challenge to Achieve Equal Opportunity and Justice and the Grand
Challenge to Ensure Healthy Development for All Youth. This wicked problem represents an
overlap in the Grand Challenge domains of individual and family well-being and that of a just
society by addressing stigma as a primary problem with regard to preventing and effectively
treating mental illness. The specific activity is designed to “address social stigma by conducting
research and raising awareness of contributions to inequity, facilitating information, education,
and social marketing campaigns that seek to reduce and change the false narratives that exist
about stigmatized populations (“Achieve equal opportunity and justice - 2018 GC fact sheet no.
12,” n.d.).”
The capstone program targets adult dependents of Active Duty Service Members,
specifically the caregiver decision-makers (parents, guardians, etc.), who are called upon to make
decisions regarding the social-emotional and psychological well-being of their children by
addressing stigma directly and, the program proposes, as a community to make meaningful
progress in this intractable social problem. Issues include the need to address multiple forms of
stigma and the impact of limited understanding of mental health and wellness on help-seeking
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 7
behaviors. Improved social-emotional and psychological functioning of military dependents are
directly related to mission readiness for the Active Duty Service Member.
The proposed program will create collaborative relationships with multiple military and
local community resources, formal and informal community leaders, and other significant
stakeholders to educate, equip, and empower decision-makers in early identification and
intervention in youth mental illness. The program will be responsible for delivering anti-stigma
programming to and, most importantly, with the community while also functioning as a one-stop
referral and navigational assistance center as it relates to mental health resources in the broader
community in collaboration with community-based resources.
There are an estimated 1.7 million children of active duty and reserve military personnel,
of whom 37.8% are 0 to 5 years of age, 31.6% are 6 to 11 years of age, and 23.8% are 12 to 18
years of age (2016 Demographics profile of the military community, 2016). When including the
Veteran population, there is an estimated 4 million youth who are military-connected (Nelson,
Baker, & Weston, 2016). Children in US military families share common experiences, but also
unique challenges, and these stressors are associated with higher rates of mental health disorder
(Huebner, 2019). Familial psychosocial stressors and mental illness impact mission readiness for
many Service Members, making it challenging to maintain focus or, worse, disrupting essential
training or deployment. Long term suffering and significant ongoing impact are preventable with
the introduction of significantly effective treatments and available psychosocial interventions.
Literature and Practice Review of Problem and Innovation
Mental health.
In 2004, the World Health Organization (WHO) defined mental health as “a state of well-
being in which the individual realizes his or her own abilities, can cope with the normal stresses
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 8
of life, can work productively and fruitfully, and is able to make a contribution to his or her
community (Promoting mental health, 2004)”. Determinants of mental health and mental
disorders include not only individual attributes such as the ability to manage one’s thoughts,
emotions, behaviors and interactions with others, but also social, cultural, economic, political
and environmental factors such as national policies, social protection, living standards, working
conditions, and community social supports (Comprehensive mental health plan 2013-2020,
2013). Exposure to adversity at a young age is an established preventable risk factor for mental
disorders. The WHO states clearly that mental health promotion and prevention are crucial to
helping adolescents thrive.
The National Alliance on Mental Illness (NAMI) indicates a staggering 50 percent of all
mental illness starts by age 14, with one in five youth experiencing a diagnosable mental health
condition ("Mental Health By the Numbers," n.d.). Untreated mental illness in children and
adolescents is a significant social problem. Estimates range from 60-80% of youth not receiving
indicated services, with the most conservative data showing 50% by the National Alliance on
Mental Illness ("Mental Health By the Numbers," n.d.).
It is estimated that one in four American adults experiences mental illness at some point
in their lives ("Mental Health By the Numbers," n.d). Estimates for youth mental illness indicate
one in five experience a diagnosable condition at some point in childhood, adolescence, or early
adulthood ("Mental Health By the Numbers," n.d). Unfortunately, military-affiliated youth are at
increased risk of developing symptoms of mental illness and experiencing poorer well-being due
to the unique experiences of these children and adolescents when compared to their civilian
counterparts (Cedarbaum et al., 2014). Padden and Agazio (2013) identified four distinct
stressors for military-affiliated youth to include deployment and relocation, family separation,
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 9
adaption to danger, and unique military culture. Of note, mental illness can cause significant
stress and discord in families.
Stigma.
Stigma, defined in the Merriam-Webster dictionary, is “a mark of shame or discredit” and
can be applied to numerous characteristics, traits, and experiences ("Definition of stigma," n.d.).
Stigma related to mental health is often associated with negative beliefs about competence,
blame, and responsibility, as well as dangerousness about an individual. Family members of
those experiencing a mental health condition may be ostracized, shamed, and even blamed for
the mental health condition of the family member. This likely represents a unique challenge for
Active Duty Service Members and their families who face the expectation that they and their
families are “squared away.”
Sheehan, Niewelowski, and Corrigan (2017), define stigma types as follows:
Stigma type Definition
Public stigma Public endorsement of prejudice and discrimination
toward minority group
Self-stigma Person in minority group internalizes public
stereotypes/prejudices and applies them to his or her life
Label avoidance Person with mental illness avoids engaging in activities
that reveal his/her diagnosis
Structural stigma Public and private sector policies that unintentionally
restrict opportunities of the minority group
Courtesy stigma Stigma experiences by those who are in close contact with
the stigmatized group (mental health workers, friends,
family)
Stigma power A means through which stigmatizers maintain social
power through control, exploitation, and exclusion of the
stigmatized group
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 10
Automatic stigma Stigmatizing thoughts, feelings, and behaviors that occur
automatically with little or no conscious awareness
Double stigma or multiple stigma Stigma which is compounded by membership in more
than one stigmatizing group (LGBT, poor, obese, etc.)
Table: types and definitions of stigma
The capstone focuses on ameliorating public stigma, self-stigma, and courtesy stigma
while addressing other forms of stigma related to mental illness. Patrick Corrigan (2004) from
the University of Chicago writes on the impact of both public and self-stigma as being
significant psychological barriers to accessing care. Public stigma affects people by causing
“harm to social opportunities” to include employment, housing, and frequently increased contact
with law enforcement and the criminal justice system (Corrigan, 2004). Self-stigma is thought to
cause “harm to self-esteem” by internalizing publicly endorsed stigmatizing beliefs about those
experiencing mental or behavioral health issues (Corrigan, 2004). Treatment avoidance can more
accurately be conceptualized as label avoidance to escape the threat of stigma by self and others.
Erving Goffman, a sociologist, referred to the stigma experienced by people in a
relationship, biological and chosen, with mental illness as courtesy stigma (Goffman, 1963).
Larson and Corrigan (2008) posit that family stigma, another term for courtesy stigma, contains
the stereotypes of “blame, shame, and contamination”, wherein family members are blamed for
the onset of mental illness or for failure to comply and follow through with prescribed treatment,
experience shame for the attributed blame and engage in avoidance of support and helping
resources, and be subjected to the belief that the close association with a person with a mental
illness may lead to decreased worth.
Under the theoretical parameters of Goffman, each individual manages their relationships
by trying to project their ideal public image (Goffman, 1963). In lay terms, we tend to put our
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 11
desired image on display and hide less desired traits or characteristics. This tendency to “put our
best foot forward” appears to be significantly linked to stigma, lack of knowledge, and limited
engagement in treatment activities, as well as effective policy-level interventions to address
mental illness in America.
The Social Ecological Model and community engagement.
The capstone project is based on a socio-ecological model as a framework for prevention,
frequently found in the public health sector. The socio-ecological model lends itself to the
project with a focus on interactive complexities of health issues and the individual, in
interpersonal relationships, as well as the broader community and the influence of societal
factors. It also requires consideration of the context in which a problem or condition is of
concern; thus, the approach taken in an urban area will differ significantly from a small rural
community and again from a military installation. Context also considers factors to include race,
socioeconomic status, and general environment while still acknowledging that individuals will
interact and be impacted differently.
Figure 1: CDC four-level model of the factors
affecting health that is grounded in the social
ecological theory (2007).
Using the Social Ecological Model, professionals and community partners can design
interventions to target various levels of the scheme that are unique to the population and
• Individual level encompasses individual
biology and other factors such as age,
education, income, and personal health
history
• The second level, relationship, includes
family and friends, who are thought to
influence behavior and contribute to
experiences.
• The community level is related to the
settings in which relationships occur and
identification of factors that affect health.
• The fourth level, societal, looks at broad
factors that influence health such as policy
and social and cultural norms.
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 12
environment in which the issue occurs. A natural complement to the Social-Ecological Model is
a community-engaged partnership, which also lends itself to the project design envisioned by the
innovator. Community engagement is defined as ‘the process of working collaboratively with
and through groups of people affiliated by geographic proximity, special interest, or similar
situations to address issues affecting the well-being of those people (Principles of community
engagement, 2011).’
One specific model of a community-engaged partnership is the Active Community
Engagement (ACE) continuum that was developed by the Access, Quality and Use in
Reproductive Health (ACQUIRE) project team and is based on a review of documents, best
practices, and lessons learned during the implementation of the ACQUIRE project. In this model,
the authors conceptualize a model that moves from consultation to cooperation to collaboration
with five characteristics of engagement: community involvement in the assessment; access to
information; inclusion in decision making; local capacity to advocate for institutions and
governing structure; and accountability of institutions to the public (Principles for community
engagement, 2011).
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 13
Social Significance
Not only in the United States, but worldwide, mental illness is a leading cause of disease
and disability to children and adolescents, with an estimated 10-20% experiencing a mental
disorder (“Child and adolescent mental health”, n.d.). Left untreated, these conditions can
negatively impact the development and futures of affected youth. Depression is one of the
leading causes of disability around the globe (“Depression”, 2018). As adolescence is
characterized as the formative years, it is essential to consider the confluence of multiple
physical, emotional, and social changes, as well as exposure to poverty, abuse, and violence
lends to a unique vulnerability to the development of mental health problems. It is also during
adolescence that people acquire many of the cognitive, emotional and social resources that are
the foundation for later life health and wellbeing (“Helping adolescents thrive”, 2018).
A serious problem associated with the Grand Challenge of ensuring healthy development
for all youth is the tragically low number of youth engaged in mental health treatment. Estimates
range widely from only 15 to 50 percent receiving indicated services for mental and behavioral
health conditions, leaving millions of youth, and potentially their families to suffer unnecessarily
(Mental Health America, National Alliance on Mental Illness, youth.gov). This does not include
those who do not rise to the level of meeting diagnostic threshold, but are suffering with sub-
clinical symptoms. Reasons for non-treatment are varied and diverse, including environmental
and societal barriers to accessing care such as the location of services, transportation, time
constraints, lack of family support and cooperation, cost, insufficient coverage and lack of
insurance, waitlists and lack of available providers (Sylwestrzak, Overholt, Ristau, & Coker,
2014). Amongst youth, stigma and associated label avoidance is a frequently cited reason for
non-engagement in services. Lack of awareness about treatment benefits and poor therapeutic
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 14
alliance are identified in treatment delay and early termination of services (Sylwestrzak,
Overholt, Ristau, & Coker, 2014). In addition to being over-represented in incidence and
prevalence data, youth of color and those living in poverty are under-represented in those
receiving treatment ("Mental Health By the Numbers," n.d.). The World Health Organization
(WHO) identifies three concepts related to access to health care: physical accessibility, financial
affordability, and acceptability (Brenner, 2019). Can a person actually arrive at the location
within service hours. Can someone afford to engage in services (fees, time off, cost of
transportation, etc.)? And do they believe the care is effective and culturally appropriate?
Mental Illness and Stigma
On the National Alliance on Mental Illness (NAMI) StigmaFree website, the organization
decries the stigma as a public health concern that impacts may facets of life including
employment, housing, and social relationships. Social isolation, self and other imposed,
perceptions of dangerousness, and beliefs of irresponsibility and incompetence are examples of
prejudice and bias against those living with mental illness that may lead to discriminatory
behaviors. Those with mental illness often have a more difficult time obtaining and maintaining
employment, securing safe housing, and have an increased risk for criminalization of non-
criminal behavior. As discussed in Corrigan, these public or external experiences often lead to a
fear of rejection that results in resignation and inaction, coined “why try”? in the literature.
In a small study by Chavira et al. (2017) on parent-reported stigma and child anxiety,
41.3% of parents reported stigma related to their children’s anxiety symptoms and seeking
mental health services. Interestingly, three themes emerged regarding stigma: Parental Concern
for Negative Consequences (concern for their child in the future and the potential for teasing by
others), 2) Parent Internalized Stigma (grief and concern about the significance of their child
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 15
having a mental health problem), and 3) Negative Associations with Mental Health Treatment
(unnecessary, side effects and potential for addiction, scary).
Conceptual Framework with Logic Model Showing Theory of Change
Youth, families, and their communities are impacted by behavioral health conditions in
childhood and adolescence, and have limited ability to sufficiently address the associated
problems effectively. Youth lack the agency necessary to secure care, and are reliant on
caregivers with decision making authority to act in their interest. As presented above, caregivers
and families are likely encounter stigmatizing beliefs, attitudes, and behaviors when seeking care
for youth from both within the family and the greater community, including medical providers.
Stigma serves as a barrier to youth and families accessing treatment for child and
adolescent mental illness.
Logic Model
In the community-based Mental Health Advocacy and Navigation Partnerships for Youth
project, primary activities will include building collaborative relationships between caregivers,
schools, community-based mental health resources, and other community partners with the goal
of “bridging the gap” amongst professionals and community stakeholders; providing community
education on mental illness and mental health promotion on an ongoing basis; and the
organization of and participation in community awareness and advocacy activities with the goals
of increased education, mental health literacy, a contact with those living with mental illness.
These activities are consistent with a stigma reduction approach proposed by National
Academies of Sciences (National Academies of Sciences; Engineering; and Medicine, Division
of Behavioral and Social Sciences and Education, Board on Behavioral; Cognitive; and Sensory
Sciences, & Committee on the Science of Changing Behavioral Health Social Norms, 2016).
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 16
Outputs will be measured by the number community-school partnerships, the number of
community volunteers (professionals and service organizations) in the community, the number of
formal discussions regarding youth mental illness in the community and places youth interact,
the number of community-based awareness and education events, the number of local public
health/awareness campaigns targeting local norms, and the number of training events to increase
mental health literacy.
Outcomes
Immediate Outcomes
• Increased awareness and knowledge about youth mental illness
• Increased knowledge about the availability of effective treatments for mental illness
• Increased knowledge of where and how to seek help for suspected mental illness
• Increased awareness of the role of stigma as a barrier to accessing help
Intermediate Outcomes
• Increased consideration of the role of mental illness in day-to-day functioning and in
particular settings
• Increased caregiver confidence in ability to address children and adolescents regarding
mental health and wellness
• Increased insight regarding world views that perpetuate public and self-stigma
• Increased knowledge of the importance of communicating with youth regarding mental
illness
• Increased referrals to therapeutic resources
Overall Impact
• More effective partnerships to aid in help-seeking activities
• Increased community-level mental health literacy
• Increased community investment in developing resources to assist youth
• Increased awareness and intervention of stigmatizing beliefs, attitudes and behaviors
• Increased discussion regarding mental illness
• Increased encouragement to engage in prevention and treatment activities
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 17
Mental Health Advocacy and Navigation Partnerships (Community Collaboratives) for Youth
Problem Statement: Mental health stigma serves as a barrier to youth and families accessing treatment for child and adolescent mental
illness.
Inputs Activities Outputs Immediate
Outcomes
Intermediate
Outcomes
Overall Impact
Staff:
Program
Director;
Volunteer and
Intern
Coordinator;
two Education
and Outreach
Coordinators;
Community
Volunteers /
Student Interns
Supplies and
Trainings
(example:
Youth Mental
Health First
Aid)
Building space
at Army
Community
Services
program
building
Start-up
Funding
Community and Professional Partners
Develop and train
community
champions in the
Mental Health First
Aid (MHFA) and
Youth Mental Health
First Aid (YMHFA)
program, as well as
installation specific
resources and topics
relevant to military-
affiliated youth
***
Coordinate and host
networking
opportunities for
champions and
professionals for
sharing and
collaboration
***
Promote cultural
competency training
for champions and
professionals
***
Provide ongoing
professional
development
opportunities
# of community
champions
***
# of champions
trained in
MHFA/YMHFA
***
# of non-clinical
professionals trained
in MHFA/YMHFA
***
# of networking
opportunities for
champions and
professionals
***
# of cultural
competency
trainings/
educational
opportunities offered
***
# of professional
development
activities for clinical
and non-clinical
professionals
Increased champion
knowledge of
evidence-based
interventions for
mental health crises
***
Increased
community (non-
clinical) presence of
evidence-based
knowledge regarding
mental health crises
***
Increased champion
and professional
knowledge of
resources related to
mental illness for
youth and families
***
Increased knowledge
of culturally
competent
interventions and
approaches to
addressing mental
illness in minority
communities
Increased
networking,
education, and
collaboration to
assist families and
youth with regard to
mental illness and
available resources
***
Increased
community
discussions
regarding the mental
illness, psychosocial
wellbeing, and the
unique risk factors
for military-affiliated
youth
***
Increased
appropriate referrals
to therapeutic
interventions across
a continuum to
available installation
and community
resources.
Reduced stigma, both public expression
and personal experience (self-stigma)
as evidenced by reduced stigma
measures utilizing the Toolkit to
Evaluate Programs Meant to Erase the
Stigma of Mental Illness by Corrigan
with the Illinois Institute of Technology
on a community level through
community survey/sampling
***
Improved service delivery and
utilization of resources related to
alleviating suffering associated with
mental illness and psychological
distress measured by use of a referral
and navigational assistance service, and
data tracking by community partners
and user feedback
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 18
Caregiver Partners
Host community
conversations
regarding youth
mental illness,
psychosocial
wellness, and
stressors/risk factors
that are unique to
military-affiliated
youth
***
Operate a referral
and navigational
assistance service
available to
caregivers that
specializes in
knowledge related to
the special needs of
youth and families
***
Promote and the
availability of non-
clinical champion
availability
# of community
conversations hosted
***
# of people seeking
referral and
navigational
assistance
***
# of community
champions
Increased knowledge
of the problem of
mental illness in
youth
***
Increased knowledge
of effective
treatment availability
***
Increased knowledge
of where to seek
help for youth
***
Increased knowledge
of the availability of
non-clinical
community-based
support
Increased caregiver
confidence in ability
to start conversations
about mental health
and wellness
***
Increased
willingness to
explore help-seeking
options for youth
mental illness and
family dysfunction
***
Increased
understanding about
the risk factors and
stressors unique to
military-affiliated
youth
***
Increased
community
commitment to
investment in
developing resources
to assist youth
Reduced stigma, both public expression
and personal experience (self-stigma)
as evidenced by reduced stigma
measures utilizing the Toolkit to
Evaluate Programs Meant to Erase the
Stigma of Mental Illness by Corrigan
with the Illinois Institute of Technology
on an individual caregiver basis
***
Improved service delivery and
utilization of resources related to
alleviating suffering associated with
mental illness and psychological
distress measured by use of a referral
and navigational assistance service, and
data tracking by community partners
and user feedback
***
Increased community-level mental
health literacy as measured by
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 19
Community at Large
Establishment of a
diverse advisory
board to guide
engagement
activities and
decisions regarding
program expansion
***
Organize
community-based
events to combat
stigma and promote
mental health
literacy
# of community-
based awareness and
educational events
***
# of public health /
awareness
campaigns targeting
local norms
***
# of training events
to increase mental
health literacy, such
as MHFA/YMHFA
Increased awareness
of the problem of
mental illness in
youth, as well as the
unique risk factors
and stressors for
military-affiliated
youth
***
Increased awareness
of the role of stigma
as a barrier to
accessing treatment
***
Increased awareness
of the effectiveness
of treatment
Increased insight
regarding world
views that perpetrate
public and self-
stigma
***
Increased knowledge
of the importance of
talking about mental
illness with children
and adolescents
Increased awareness of stigmatizing
beliefs, attitudes and behaviors
***
Increased open, and supportive,
discussion regarding mental illness and
psychosocial stress, particularly related
to military-affiliation
***
Increased encouragement to engage in
treatment activities and utilize
resources intended to ease psychosocial
stress, both on and off the installation
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 20
Theory of Change
Collaborative relationships amongst informed, empowered adults with result in better
youth outcomes.
If we are able to build collaborative relationships amongst caregivers, school employees,
community-based mental health and other key stakeholders, we can then set the stage for
meaningful conversations regarding mental health concerns in the social-emotional-behavioral
and academic development of youth. By hosting on-going community conversations about
youth mental illness, we can effectively increase awareness and knowledge of the impact of
stigma on the health and well-being of youth with the ultimate goal of increased engagement in
prevention and intervention activities – and decreased unnecessary suffering. Similarly,
organizing and participating in community-based events to promote awareness and highlight the
impact of stigma has the potential to start conversations, increase awareness of stigma and
promote reflection and intervention with stigmatizing beliefs, attitudes and behaviors.
Continuing to approach the problem of stigma at an individual basis is likely to be
ineffective and resolution at a policy level seems elusive. Because of the nature of the problem,
efforts to address the health and well-being of youth are siloed and even fractured at times. The
capstone project calls for an organization that is flexible enough to “bridge the gaps” between
traditional and non-traditional care approaches and those in need of services and support. Using
a community engagement model, we can start where any community is and move to an improved
state in regard to the problem being addressed with a multi-stakeholder perspective. To effect
change in the problem of youth mental illness, we must develop the necessary resources and
environments to shape caregiver responses to identify mental health concerns and act at the
earliest signs of mental illness and promote wellness activities.
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 21
Mental Health Advocacy and Navigation Partnerships (Community Collaboratives) for Youth:
A community-based collaborative model designed to reduce stigma, as well as identify and bridge gaps in service delivery and utilization in
order to promote youth mental health and family functioning in the military dependent community.
Solution Statement/Innovation: Collaborative relationships amongst informed, empowered caregivers/adults will result in better youth mental
health outcomes.
Activities If, Then… Why? Evidence
Create a collaboration of non-clinical
individuals in the community, non-
clinical professionals, and resources in
the community
If we educate and empower the public about
mental health in the military-affiliated population,
as well as the impact of associated stigma, more
youth and families will engage in needed care
earlier thus, disrupting the development of
significant psychosocial impacts and disability
The Social-Ecological Model suggests
that wicked social problems can be
further explored and understood by
considering the individual, their
relationships, the community, and larger
societal factors
The Active Community Engagement
(ACE) continuum proposes a process by
which the community members
themselves become change agents
Social Learning Theory suggests that
behavior change can come about by the
addition of new environmental stimuli,
such as education regarding mental illness
in youth and the impact of implicit bias
and automatic stigma
Transtheoretical Theory of Change
proposes change as a process whereby the
raising awareness/consciousness is one of
the first interventions, followed by
resolving ambivalence and preparing for
change
The Health Stigma and
Discrimination Framework by
Stangl et.al. (2019)
Develop, train and deploy community-
based champions as non-clinical assets in
the community
If community members receive non-clinical
training regard mental health and crisis
intervention, more people will reach out when
dealing with a mental health concern or
contemplating assistance
The ACQUIRE project by
Russell, 2008
Host community conversations regarding
youth mental illness and the
psychosocial stressors related to
affiliation to the military and in general
If caregivers have increased awareness of mental
illness, and the impact of stigma on the health and
wellbeing of youth, more youth and families will
engage in treatment activities and with resources
intended to alleviate psychosocial stressors
Organize and participate community-
based events to combat stigma and
promote mental health literacy
If the community as accurate information about of
youth mental illness, increased awareness of types
and impact of stigma, as well as fact-based
knowledge regarding mental illness and wellness,
there will be less public stigma and increased
acceptance of engaging in help-seeking behaviors
Note: Better youth mental health outcomes means decreased incidence, prevalence, duration, severity of mental illness, as well as less significant psychosocial impact and
disability.
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 22
Problems of Practice and Innovative Solutions
Proposed Innovation and Effect on Grand Challenge
The capstone innovation is a community engagement model in which the program
promotes and functions as a bridge between various stakeholders and stands in the gap to
aggressively address stigma in the community and to facilitate meaningful partnerships that meet
real needs in service delivery and utilization. This will be accomplished through two key
activities: the development and deployment of “champions” as non-clinical assets regarding
mental health in the community and the establishment of a community collaborative for
resources that support youth and families on the installation.
Image: depicting the professional resources and supports available along with a diffusion of
“champions” in the community, denoted by a yellow circle with a “C”.
The Grand Challenge to achieve equal opportunity and justice is focused on addressing
stigma that marginalizes people and impedes quality of life, while the Grand Challenge to ensure
healthy development for all youth focuses of the prevention of mental illness and behavioral
problems in youth with special attention to the disparities seen amongst racial groups and those
of a low socio-economic status. In the literature review, it is easy to discern that these two Grand
Community
Collaborative
Schools
School
Behavioral
Health
Child,
Adolescent,
and Family
Behavioral
Health Service
Child Youth
Services
Army
Community
Services
Department of
Behavioral
Health
Army
community
members
Army Youth
C
C
C
C
C
C
C C
C
C
C
C
C
C
C
C
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 23
Challenges intersect, creating a unique opportunity to further each of these intractable issues.
While outside the purview of this paper, a logical argument could be made regarding impact to
the Grand Challenge to eradicate social isolation, as social isolation is a natural companion to
social isolation, and the effort to deepen social connection and community to the affected
population. In this way, the capstone project is at the center of Grand Challenge efforts to
address individual and family well-being, create a stronger social fabric, and realize a just society
in which individuals are fully honored as an integral part of a diverse world population.
Image: Venn diagram demonstrating intersectionality of Grand Challenge efforts represented in
the project.
Creating constructive, authentic discussion around youth mental health and illness has the
potential to engage more youth and families in preventative and treatment activities. As
previously cited by the National Academy of Sciences (2016), anti-stigma activities, include
education, increasing mental health literacy, creating opportunities for contact with those living
with mental illness, and peer support. One of the benefits to the design is the flexibility for each
community to address various issues that impact their community in a way the “fits” the local
culture. Military communities are often characterized as tight knit communities that function as a
Address Individual
and Family Well-
being
Create a
Stronger Social
Fabric
Realize a Just
Society
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 24
family away from home, thus friends and neighbors fill the traditional role of family consultation
and support. The use of community champions, who are trained to address stigma and mental
health basics, is likely sure to fill a need in military communities.
Views of Key Stakeholders
Stakeholder input was sought in a variety of ways to include formal and informal
interviews and surveys with professionals, non-clinical professionals, Active Duty Service
Members and civilians, males and females, though most were college educated, at least to the
baccalaureate level. Feedback included the belief that stigma is mostly a community problem
that appears to have lessened over time. One Service Member wrote the following, used with
permission:
“My wife and I currently have two teenage children who are involved in counseling for various reasons. I
am active duty military and have been away from my family a lot over the past 18 1/2 years. Being in for
as long as I have I fell into the culture of, if you can’t handle something and need to seek a therapist
you’re weak. Unfortunately, I allowed that stigma to control decisions at home regarding my children. I
always said a certain activity or behavior was a phase, or they’re just being lazy. Luckily, I wasn’t the end
all be all in the decision-making process. After talking for some time to me about issues, and markers for
issues one of our children was exhibiting, I agreed to counseling for them. I said it was a trial basis and
I’d wait and see. It’s now been several years and the difference it’s made is noticeable day in and day out.
The behavior change and way they go about things is refreshing. It caused me to take a long hard look at
how I viewed mental health issues and the help needed for them. Our second child in counseling started
so they’d have someone they felt they could talk to without being judgmental and a third-party sounding
board. I believe this has helped them as well in dealing with stress, and possibly even preventing
recurring and damaging behaviors. If asked even five years ago if I thought there were real benefits of
children getting help for issues like this I would have been highly skeptical, now, however, I am a firm
believer that the earlier we as parents can identify an issue/potential issue and get our children the help
they need, the better off they will be. “
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 25
The formation of an advisory board is essential to the on-going evolution and
effectiveness of the program to address stigma and to determine essential next steps in the
community while ensuring stakeholders concerns are addressed. The advisory board should
include a variety of stakeholders to include racial, ethnic, and gender diversity while ensuring
representation of youth and those with lived experience as it relates to mental health or other
stigmatized statuses. The establishment of a continuous feedback loop is essential to ensuring
the vitality of the advisory board and engagement in forming the “what and how” of specific
project activities.
There are tentative plans for either a focus group or table top exercise with the Family
Advocacy Program Manager at the beginning of November 2019.
Evidence and Current Context for Proposed Innovation
History of mental illness and stigma.
Mental illness has long been a stigmatized condition, with those who experience mental
illness subject to prejudice, bias, and discriminatory actions. While many of the torturous and
de-humanizing practices addressing mental illnesses are no longer prevalent, stigmatization and
discrimination persist on a broad level and throughout many societies. Erving Goffman is the
sociologist credited with first considering the concept of stigma with those experiencing mental
An article by the Mayo Clinic staff identifies reluctance to seek help or treatment; lack of
understanding by family, friends co-workers or others; fewer opportunities for work, school or
social activities, or trouble finding housing; bullying, physical violence, or harassment; health
insurance that doesn’t adequately cover your mental illness treatment; as well as the belief that
you’ll never success at certain challenges or that you can’t improve your situation as some of the
harmful effects of stigma ("Mental health: Overcoming the stigma of mental illness," 2017). An
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 26
online resource against stigma by NAMI, StigmaFree Me, identifies attitudinal effects to include
alienation and devaluation of those with mental illness, as well as beliefs that those with mental
illness are dangerous, irresponsible, or, even incompetent ("StigmaFree Me," n.d.). These same
individuals are less likely to be hired and able to secure safe housing, while they are more likely
to encounter the legal system due to the criminalization of certain behaviors. Perhaps most
harmful, those who experience stigmatization are likely to internalize their experiences and fear
the potential for rejection, that they may not pursue opportunities to achieve their dreams.
Stigma is a powerful force that separates and devalues through social distance and other
mechanisms.
Mental Health and Stigma Policies.
There are many policies, regulations and programs that related to mental illness and
treatment, but few address the impact and effects of stigma. The Americans with Disabilities
Act prohibits discrimination on the basis of mental illness. This legislation is more applicable to
issues of overt behaviors of individuals and institutions.
Mental Health Practice.
Mental health care is at a time where there are more effective treatments than ever to treat
using pharmacotherapy, evidence-based and experimental therapies. Another important change
is an increased commitment to person-centered care and recovery-oriented frameworks.
Unfortunately, these interventions are often diluted secondary to treatment avoidance and
ineffective engagement.
Public Knowledge and Discourse.
A quick scan of news and social media reveals a somewhat dichotomous societal view of
mental illness and stigma. Many individuals are taking to Facebook, Twitter, and Instagram
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 27
sharing about their own experiences with mental illness, this includes the public at large and
celebrities, and using social movements such as NAMI’s own #StigmaFree and
#depressionsucks. Other news and media outlets continue to perpetuate, wither through
carelessness or ignorance, the stereotypes of dangerousness, unpredictability, and “otherness.”
A timely topic of concern is that related to unpresented numbers of very public, mass
shootings. One side argues that it is a gun control issue, the other – a mental health issue, despite
several well-known facts about past mass shooters.
Contextual Environment.
Evidence indicates we are seeing an increase in teen mental illness over the past decade.
One potential culprit being thoroughly investigated is the advent and pervasive presence of social
media as a steady diet in the lives of adolescents and increasingly in children. Other problems
that indicate an innovation related to mental health treatment include rising rates of youth suicide
and high-profile suicides. There is also frequent debate about the role of mental illness and
social isolation in a rash of school/mass shootings.
Comparative Assessment of Other Opportunities for Innovation
Effort were made to ensure that the innovative program represented a unique solution to
this wicked problem by completing a landscape analysis. Much of the work being done around
the issue of stigma is done via committed agencies and vigorous online social marketing
campaigns as represented by the #StigmaFree and #CureStigma campaign championed by
NAMI. Other campaigns can be seen at B4Stage4 with Mental Health America and Seize the
Awkward on the Ad Council webpage and YouTube. It is also becoming increasing common for
celebrities and social media influencers to share messages regarding their own mental health
status or an anti-stigma message on their personal social media pages.
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 28
Another approach has been to educate youth via Social Emotional Learning (SEL)
programs in the school setting. These programs, such as Second Step or RULER from Harvard,
are considered evidence-based practices to educating children about difficult emotions and how
to handle them. The issue remains, from a Systems Perspective, when adult caregivers aren’t
also explicitly included in the intervention. Another potentially competing solution comes in the
form of School Behavioral Health services, which appear to assist in overcoming logistical
barriers, but perhaps less so with psychological barriers such a stigma.
Project Structure and Methodology
Description of Capstone Deliverable/Artifact
The capstone deliverable is an unsolicited proposal to pilot a program on the Fort Riley
military installation through the Army Community Services program, which is a non-clinical
parent program with a focus on prevention and wellness activities targeting military families.
The proposed program supports the training and diffusion of “champions” throughout the
installation who are uniquely prepared to address stigma, public and self, and to provide correct
information about mental/behavioral health and how to access resources. In addition to the
diffusion of mental health champions in the community, a small group of employees along with
volunteers will coordinate the delivery of community level education, resource referrals, and
navigational assistance. This two-pronged approach is designed to address barriers to accessing
care in order to decrease suffering associated with mental and behavioral health issues for youth
and their families.
Comparative Market Analysis
There are several programs available that make use of “gatekeepers” or “champions”, but
they are typically geared to suicide prevention efforts. Likewise, there are multiple programs
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 29
and initiatives that are designed to address stigma, but fail to do so on a community versus
individual level. Anti-stigma campaigns are largely online and can be found at websites such as
NAMI with the #StigmaFree and #CureStigma campaigns or Mental Health America’s
B4Stage4. NAMI has also just introduced an educational program to parents, caregivers and
other family members who care for a youth experiencing mental health symptoms. Similarly,
many schools have implemented Social Emotional Learning (SEL) programs such as, but parents
are left to their own in regard to integration and these approaches fail to recognize stigma as a
barrier to attitude and behavior change. The innovator believes that the designed community
engagement approach will fill the gap between awareness and action.
Project Implementation Methods
Post literature review implementation steps have included meeting with and gathering
feedback from a variety of stakeholders through formal and informal interviews and surveys with
plans to conduct a formal focus group or tabletop exercise with key stakeholders on Fort Riley in
the Army Community Services program through known network contacts. Next steps include the
creation of a diverse advisory board with an effective continuous feedback loop, a community
needs assessment, and presentation to Fort Riley Garrison leadership for approval. Once the
pilot is approved and underway, staff and the program director will gather data as indicated in
the logic and program models to demonstrate effectiveness and opportunities to shift activities to
meet the intent of the program. Two guiding principles will be used to determine success: are we
staying on task with decreasing stigma and is stigma decreasing? After the Fort Riley pilot is
able to demonstrate a positive effect, the program director in collaboration with higher leadership
will seek to gain support to implementation at additional Army installations and eventually
diffuse the innovation to all Department of Defense installations.
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 30
Financial Plans and Staging
Financing for the innovation is requested from the Garrison commander to run the
program. The intent is that the program would run under the Army Community Services
program as it is well-established in the community and is host to programs that are
complimentary to the biopsychosocial wellbeing of the military community. It is not necessary
to form a separate corporation or agency with the current design plan. The two main categories
for costs are staff and volunteer/community training. The financial plan calls for three full-time
employees and a high level of funding for training activities for both staff and
volunteers/champions as the involvement of informed and empowered community members is
essential to the design.
Phase I –
Exploration of
problem,
innovation
COMPLETE
Phase II –
Preparation:
Current
Meeting with
collaborative
partners
Phase III –
Present to
Family Advocacy
Program
Manager for buy
in and support
Phase IV -
Present to
Garrison
Commander for
Approval to Run
Pilot
Phase V - Run
Pilot at Fort
Riley, KS
Phase VI -
Staggered
Implementation
at Additional
Installations
Phase VII -
Nationwide
Implementation
Fort Riley Installation Implementation Plan
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 31
Project Impact Assessment Methods
The project aims to both reduce stigma and improve mental/behavioral health service
delivery and utilization. As such, desired outcomes involve measures of reduced stigma for the
individuals, with the ultimate goal of reducing community-level stigma, as well as increased
engagement with community mental/ behavioral, as well as psychosocial, organizations and
agencies, particularly therapy for youth under the age of 18. Patrick Corrigan from the Illinois
Institute of Technology has made available the Toolkit for Evaluating Programs Meant to Erase
the Stigma of Mental Illness that offers access to copyrighted measures to assist in measuring
impact of local programming with regard to stigma. The three groups of stigmas conceptualized
by Corrigan and colleagues includes public stigma, self-stigma, and label avoidance. The
Toolkit offers an Anti-Stigma Worksheet to assist in delineating what type of stigma is to be
addressed by specific interventions and the ability to design an effective evaluation plan. While
it is simplistic in nature, it allows entities who are no research-oriented users to collect data on
the effectiveness of their programs. The publication also offers an example of how one might use
the information to evaluate a program that is likely useful to non-researchers.
Expenses
Personnel/Salaries
Program Supervisor 89,000 Master's level social worker (1FTE) (clinical) - GS-13
Education and Outreach Workers (3) 155,000 Master's level social workers (3 FTE) (non-clinical) - GS-9
Benefits 73,200 30% of salaries
Total Personnel Expenses 317,200
Operating Expenses
Rent 24,000 space rental (2,000/month)
Furniture 30,000 desks, chairs, table
Technology & Communications 24,000 laptops (4)/ cell phones (4) (2,000/month)
Marketing, Material and Supplies 30,000 copies, incentives, and promotional items (2,500/month)
Travel/Transportation 24,000 mileage/training travel expenses (2,000/month)
Training 20,000 MHFA/YMHFA (x4) (and costs for providing training to partners)
Volunteer related expenses 30,000 training, recognition, and appreciation
Total Operating Expenses 182,000
Total Expenses 499,200
Year One Line-item Budget
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 32
The primary approach for program evaluation employs the Toolkit for Evaluating
Programs Meant to Erase the Stigma of Mental Illness from Patrick Corrigan (2018) from the
Illinois Institute of Technology guides the evaluation of the proposed program. It includes
empirically tested measures in regard to public stigma and self-stigma and are primarily designed
to measure attitudes.
Public Stigma.
There are three versions of the Attribution Questionnaire: a 27-item version (AQ-27), a
nine item (AQ-9), and a short form for children (AQ-8-C) and were developed to measures nine
stereotypes about people with mental illness: blame, anger, pity, help, dangerousness, fear,
avoidance, segregation, and coercion. A fourth measure is the Family Questionnaire (FQ), a 12-
item measure, which looks at public stereotypes about family members of people with mental
illness.
Self-Stigma.
The Self-Stigma of Mental Illness Scale (SSMIS) assesses Awareness, Agreement,
Application, plus Hurt, recognized as four constructs of self-stigma, where are the Recovery
Assessment Scale (RAS) is used to focus on the positive aspects of recovery. Five factors are
considered: personal confidence and hope; willingness to ask for help; goal and success
orientation; reliance on others; and not dominated by symptoms.
Level of Familiarity.
According to Corrigan, research shows that people who are more familiar with mental
illness are less likely to engage in stereotyping. The Level of Familiarity Scale in an eleven-item
instrument that approximates the level of familiarity for the participant.
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 33
Program evaluation has been designed to look at engagement with the community,
changes in attitude, and also changes in behavior. While "output" generally measures of what
the agency is doing, it is important in this context to understand what and how the community is
interacting with the collaborative, i.e. more contacts is likely an indicator of change in the
community.
In addition to efforts to reduce stigma, engagement with helping resources is a second
desired outcome. This activity will be tracked first as an output via referrals made, and later with
partner organizations and agencies as changes to rates of accessing services via annual reporting
data, as well as user report of accessing services following referrals as it relates to outcomes.
Stakeholder Engagement Plan
Stakeholders are an essential element to the design as the needs of the community and
available resources shift over time and are influenced by geographical region and local policy.
Stakeholders will be invited to participate in a number of ways and at varying levels. Initial
efforts will be to through outreach activities in the community and in the housing community
centers via educational offerings. Stakeholders can provide information and feedback wither
formally or informally they can train to be champions, they can volunteer to co-facilitate
educational sessions or walk alongside a family as a navigator.
Communication Strategies and Products
Communication plan includes the use of the installation newspaper, advertising in the
Morale, Welfare, and Recreation guide which highlights many Army Community Services
activities, and the post Facebook page. The innovator is creating a #StandInTheGap social
marketing campaign to both assist in the recruitment of champions and advertise the referral and
navigational support available through the program’s collaborative efforts. The campaign will
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 34
feature various types of gaps (in teeth, in jeans, in tile, etc.) and will highlight the gap in
community connection created by stigma. Views will then be asked to “stand in the gap” to help
overcome the effects of stigma.
In addition, an informational brochure that highlights services to caregivers is being
conceptualized at this time. It will include information about the community conversations, how
to obtain assistance in navigating available resources, and a quick reference guide to telephonic
and online resources regarding child and adolescent mental illness and psychosocial wellness.
In regard to programmatic and academic communication, the innovator will prepare
required reports for parent organization leadership and the advisory partners. This will include
monthly and annual report in regard to program performance and outcome metrics, as well as
financial reports to fine tune the proposed budget to ensure efficiency in addition to effectiveness
of the interventions.
Ethical Considerations
The most significant ethical consideration comes from training people in the community
to respond to potential crises with regard to impact on others, as well as impact to the individual
champion as there will be difficult cases that include the potential for exposure to suicide. There
will need to be a standard operating procedure to deal with volunteers who become
overwhelmed, burned out, or experience a catastrophic outcome as a part of their volunteerism.
Conclusions, Actions and Implications
Summary of Project Plans
The project aims to address the problem of stigma of mental and behavioral health
conditions as a community with the ultimate goal of engaging youth and their families in
services at earlier stages of mental health concerns. The use of community champions and
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 35
development of an effective community collaborative model will promote the use of available
resources for mental health disorders and psychosocial stressors. Once piloted and evaluated for
effectiveness and future iterations, the project stands to be replicated in military and non-military
communities. By successfully addressing stigma as a community issue versus an individual one,
we can access the power of human connection to begin healing and provide hope for children
and youth experiencing mental and behavioral health issues.
Current Practice Context for Project Conclusions
The project is well-poised to continue work aimed at addressing childhood and
adolescent mental health, aimed at joining the push to include Social Emotional Learning in the
classrooms and School Behavioral Health in schools. This work can influence a more difficult to
reach population by leveraging the power of human connectedness and non-clinical champions
in the lives of military dependents. The project also harnesses the power of a social movement
that promotes talking about mental and behavioral health issues and reaching out in an authentic
way to family, friends, and acquaintances.
Project Implications for Practice and Further Action
Implications for the proposed capstone may include the need for an increase in already
taxed age-competent services for youth and their families. There is a national shortage of child
and adolescent psychiatrists, psychologists, therapist and other mental health support workers.
As such, professional acknowledgment of this shortage needs to occur with special emphasis on
developing this specialty, which is necessary given the recent attention to building trauma-
informed schools and communities.
Project Limitations
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 36
Proposing a pilot on a military installation represents a significant challenge to move to
implementation as most ideas for programming come from within or from above via
congressional mandates and legislation. The bureaucratic processes may prove to be too much
of a challenge to move forward. The opportunity to pilot though is exciting due to the ability to
replicate across installations with a fairly consistent population, which allows for greater ability
to study the program in a meaningful way.
Conclusion
The Mental Health Advocacy and Navigational Partnerships community collaborative
program represents an innovative approach to stigma reduction and improved service delivery
and utilization by harnessing the power of community and connection within military
communities. This is accomplished on two levels with the diffusion of lay volunteers throughout
the community and powerful, effective networking amongst volunteers, non-clinical
professionals, and those directly linked to mental/behavioral and social services. Tackling
stigma as a community has the potential to increase discussion and help-seeking related to
mental illness and behavioral disturbance for military youth and families to disrupt the norm of
waiting for a crisis to access resources.
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 37
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promoting equality by addressing social stigma (#18). Retrieved from American
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Academy of Social Work and Social Welfare website:
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Challenge-of-Promoting-Equality-by-Addressing-Social-Stigma1-1-2.pdf
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Sciences and Education, Board on Behavioral; Cognitive; and Sensory Sciences, &
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Sheehan, L., Nieweglowski, K., & Corrigan, P. W. (2016). Structures and Types of Stigma. The
Stigma of Mental Illness - End of the Story?, 43-66. doi:10.1007/978-3-319-27839-1_3
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doi:10.1007/s10597-014-9776-x
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Prototype: Unsolicited Proposal
Daffney Kubler-Hoffman
University of Southern California
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 43
Abstract
Mental health is a significant problem in the United States and abroad, with depression identified
as the number one cause of disability in the world. One in five American children and
adolescents have a diagnosable mental or behavioral health condition, and only a fraction of
youth in need of care are engaged in treatment (Mental health by the numbers, n.d.). Public
stigma, self-stigma, and label avoidance are identified as significant psychological barriers to
accessing care (Corrigan, 2004). Military youth dependents are at risk to experience a number of
life stressors due to their affiliation with the military community related to deployments and
reintegration, frequent moves, and overall stressors for military families (Huebner, 2019).
Children and adolescents lack the knowledge and agency to seek and engage in therapeutic
interventions, thus must rely on informed, empathetic, and empowered caregiver decision
makers.
The proposed program focuses on the dependents of Active Duty Service Members,
specifically the caregiver decision-makers (parents, guardians, etc), who are called upon to make
decisions regarding the social-emotional and psychological well-being of their children by
addressing stigma directly and, the program proposes, as a community to make meaningful
progress in this intractable social problem. Issues include the need to address multiple forms of
stigma and the impact of limited understanding of mental health and wellness on help-seeking
behaviors. Improved social-emotional and psychological functioning of military dependents is
directly related to mission readiness for the Active Duty Service Member.
The proposed program will create collaborative relationships with multiple community
resources, formal and informal community leaders, and other significant stakeholders to educate,
equip, and empower decision makers in early identification and intervention in youth mental
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 44
illness. The program will be responsible for delivering anti-stigma programming to and, most
importantly, with the community while also functioning as a one-stop navigational assistance
shop as it relates to mental health resources in the larger community in collaboration with
community-based resources.
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 45
Project Description
Problem and population
There is an alarming social norm of waiting until there is a crisis to seek mental health
services for our children and teens. National Alliance on Mental Illness shares that there is an
average gap of 8-10 years between the onset of symptoms and the first episode of treatment
("Mental Health By the Numbers | NAMI: National Alliance on Mental Illness," n.d.). Multiple
forms of stigma frequently lead to a practice identified as “label avoidance” in the literature that
is accomplished by treatment avoidance and the result is unnecessary suffering for youth, discord
within families, substance abuse, social disconnect, increased incidence of law enforcement
contact, educational drop-out and, ultimately, increased morbidity and mortality of our youth.
Padden and Agazio identified four distinct stressors for military-affiliated youth to
include relocation, family separation, adaption to danger and unique military culture. Familial
psychosocial stressors and mental illness impact mission readiness for many Service Members,
making it difficult to maintain focus or, worse, disrupting essential training or deployment.
Unfortunately, military-affiliated youth are at increased risk of developing symptoms mental
illness, and experiencing poorer well-being due to the unique experiences of these children and
adolescents (Cedarbaum, 2014). Long term suffering and ongoing significant impact are
preventable with the introduction of significantly effective treatments for depression, anxiety,
PTSD, and other serious mental illnesses. Our generation is uniquely poised to move into a
position of improved prevention efforts, if we act.
Unfortunately, stigma is a tremendous barrier to engaging in help seeking behavior to
both youth, and their families who are also often stigmatized. Public stigma, self-stigma,
perceived stigma, anticipated stigma, and courtesy stigma all create psychological challenges to
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 46
seeking and effectively engaging in mental and behavioral health treatment. We must overcome
stigma to increase access and effective utilization of mental and behavioral health services across
a continuum for youth and families. By addressing stigma directly, and as a community, we will
be able to subvert the norm of avoiding mental health services until a crisis occurs, or worse –
death by suicide - and operate from a new deviant norm of seeking mental health services at
early signs of mental illness in our children and youth to learn how to manage mental and
behavioral health conditions effectively, with the support of the community. We will be more
successful in moving mental health into prevention if we can meaningfully eradicate the multi-
faceted problem of mental health stigma in the Army community.
Literature Review
Mental Health
In 2005, the World Health Organization (WHO) defined mental health as “a state of well-
being in which the individual realizes his or her own abilities, can cope with the normal stresses
of life, can work productively and fruitfully, and is able to make a contribution to his or her
community (citation)”. Determinants of mental health and mental disorders include not only
individual attributes such as the ability to manage one’s thoughts, emotions, behaviors and
interactions with others, but also social, cultural, economic, political and environmental factors
such as national policies, social protection, living standards, working conditions, and community
social supports. Exposure to adversity at a young age is an established preventable risk factor for
mental disorders. The WHO states clearly that mental health promotion and prevention are key
to helping adolescents thrive.
The National Alliance on Mental Illness (NAMI) indicates a staggering 50 percent of all
mental illness starts by age 14, with one in five youth experiencing a diagnosable mental health
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 47
condition ("Mental Health By the Numbers | NAMI: National Alliance on Mental Illness," n.d.).
Untreated mental illness in children and adolescents is a significant social problem. Estimates
range from 60-80% of youth not receiving indicated services, with the most conservative data
indicating 50% by the National Alliance on Mental Illness ("Mental Health By the Numbers |
NAMI: National Alliance on Mental Illness," n.d.). Youth lack agency, as well as decision-
making authority, required to access needed mental health services thus must rely on informed,
capable caregivers.
Mental illness does not discern, but it is undoubtedly opportunistic. It is estimated that
one in four American adults experiences mental illness at some point in their lives.). Estimates
for youth mental illness is closer to one in five experiencing a diagnosable condition at some
point in childhood, adolescence or early adulthood. While outside of the scope of this review,
youth with adverse childhood events (ACEs) are more likely to experience mental and
behavioral disturbances. Of note, mental illness can cause significant stress and discord in
families.
Stigma
Stigma, defined in the Merriam-Webster dictionary, is “a mark of shame or discredit” and
can be applied to numerous characteristics, traits and experiences. Stigma can be applied to many
observable (skin color, behavior, and physical deformity to identify a few) and unobservable
attributes, such as internal experiences including physical health disorders, ancestry, and mental
illnesses. Stigma related to mental health is often associated with negative beliefs about
competence, blame and responsibility, as well as dangerousness about an individual (citation).
Family members of those experiencing a mental health condition may be ostracized, shamed and
even blamed for the mental health condition of the person (citation). This likely represents a
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 48
unique challenge for Active Duty Service Members and their families who face the expectation
that they and their family are “squared away”.
Sheehan, Niewelowski, and Corrigan (2017), define stigma types as follows:
Stigma type Definition
Public stigma Public endorsement of prejudice and discrimination
toward minority group
Self-stigma Person in minority group internalizes public
stereotypes/prejudices and applies them to his or her life
Label avoidance Person with mental illness avoids engaging in activities
that reveal his/her diagnosis
Structural stigma Public and private sector policies that unintentionally
restrict opportunities of the minority group
Courtesy stigma Stigma experiences by those who are in close contact with
the stigmatized group (mental health workers, friends,
family)
Stigma power A means through which stigmatizers maintain social
power through control, exploitation, and exclusion of the
stigmatized group
Automatic stigma Stigmatizing thoughts, feelings, and behaviors that occur
automatically with little or no conscious awareness
Double stigma or multiple stigma Stigma which is compounded by membership in more
than one stigmatizing group (LGBT, poor, obese, etc.)
Table 1: types and definitions of stigma
In addition to logistical barriers related to health care access such as transportation, time
off from work, and cost, many social norms appear to keep youth from getting mental health help
promptly, if at all. A prime culprit is a propensity of caregivers to wait until there is some sort of
clear, discernible sign – often a crisis – to access mental health care for their children. The
National Alliance on Mental Illness (NAMI) shares that there is an average 8-10 year gap
between the onset of mental/behavioral health symptoms and the first episode of care.
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 49
Moreover, this is only amongst diagnosable conditions and does not capture those struggling at
subclinical levels. This practice must stop to make a difference in the lives of youth.
The capstone focuses on ameliorating public stigma, self-stigma, and courtesy stigma
while addressing other forms of stigma related to mental illness. Patrick Corrigan (2004) from
the University of Chicago writes on the impact of both public and self-stigma as being
significant psychological barriers to accessing care. Public stigma affects people by causing
“harm to social opportunities” to include employment, housing, and frequently increased contact
with law enforcement and the criminal justice system. Self-stigma is thought to cause “harm to
self-esteem” by internalizing publicly endorsed stigmatizing beliefs about those experiencing
mental or behavioral health issues. Treatment avoidance can more accurately be conceptualized
as label avoidance to escape the threat of stigma by self and others.
Erving Goffman referred to the stigma experienced by people in relationship, biological
and chosen, with mental illness as courtesy stigma (Goffman, 1963). Larson and Corrigan
(2008) posit that family stigma contains the stereotypes of “blame, shame and contamination”,
wherein family members are blamed for the onset of mental illness or for failure to comply and
follow through with prescribed treatment, experience shame for the attributed blame and engage
in avoidance of support and helping resources, and be subjected to the belief that the close
association with a person with a mental illness may lead to decreased worth.
Under the theoretical parameters of Erving Goffman, a sociologist, each individual
manages their relationships by trying to project their ideal public image (Goffman, 1963). In lay
terms, we tend to put our desired image on display and hide less desired traits or characteristics.
This tendency to “put our best foot forward” appears to be significantly linked to stigma, lack of
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 50
knowledge, and limited engagement in treatment activities, as well as effective policy-level
interventions to address mental illness in America.
The Social Ecological Model --- Community Collaborative
The capstone project is based on a socio-ecological model, found frequently in the public
health sector. The socio-ecological model lends itself to the project due to the focus on the
interactive complexities of health issues and the individual, in interpersonal relationships, as well
as the larger community and the influence of societal factors. It also requires consideration of
context in which a problem or condition is of concern; thus, the approach taken in a metropolitan
area is likely to differ greatly from that in a small rural community. This is particularly
important when considering implementation on a military installation. Context also considers
factors to include race, socioeconomic status, and general environment while acknowledging that
individuals will interact and be impacted differently. Using the Social Ecological Model,
practitioners and community partners are able to design interventions to target various levels of
the scheme that are unique to the population and environment in which the issue occurs.
Figure 1: CDC four-level model of the factors
affecting health that is grounded in the social
• Individual level encompasses
individual biology and other
factors such as age, education,
income, and personal health
history
• The second level, relationship,
includes family and friends, who
are thought to influence behavior
and contribute to experiences.
• The community level is related to
the settings in which relationships
occur and identification of factors
that affect health.
• The fourth level, societal, looks at
broad factors that influence health
such as policy and social and
cultural norms.
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 51
ecological theory (2007).
A natural complement to the Social Ecological Model is a community-engaged
partnership, which also lends itself to the project design envisioned by the innovator.
Community engagement is defined as ‘the process of working collaboratively with and through
groups of people affiliated by geographic proximity, special interest, or similar situations to
address issues affecting the well-being of those people.’ One specific model of a community
engaged partnership is the Active Community Engagement (ACE) continuum that was
developed by the Access, Quality and Use in Reproductive Health (ACQUIRE) project team and
is based on a review of documents, best practices, and lessons learned during the implementation
of the ACQUIRE project. In this model, the authors conceptualize a model that moves from
consultation to cooperation to collaboration with five characteristics of engagement: community
involvement in the assessment; access to information; inclusion in decision making; local
capacity to advocate for institutions and governing structure; and accountability of institutions to
the public.
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 52
Proposed Work
The proposed Mental Health Advocacy & Navigation Partnerships program is a
community-based collaborative model designed to reduce stigma, as well as identify and bridge
gaps in service delivery and utilization in order to promote youth mental health and family
functioning by using a community engagement model. The model is proposed to best understand
barriers and facilitators to overcoming stigma and accessing care in any given locale as each
area, and available resources, is as unique as the population residing there. The community
collaborative is a collection of community members (volunteers) and community-based
organizations, agencies, and professionals committed to addressing the effects and impact of
social stigma related to mental illness on the wellbeing of youth, and their families, who are
willing to be trained to address social stigma and misinformation at various levels in the
community. The approach is derived from a Public Health Model and proposes that
collaborative relationships amongst informed, empowered adults will result in better youth
mental health outcomes. This requires a coordinated, intentional community effort of effective
service organizations and supports, in addition to well-informed individuals in the community.
A second, equally important, component is the operation of an effective, “no wrong door”
approach to community resources that support the social and psychological wellness of Army
community members.
Goal: The overarching goal is improved mental health for military-affiliated youth, ages 0-18,
with decreased disparities in terms of utilization of services by those of racial minorities and
those with a low socio-economic status. Reference: American Academy of Social Work and
Social Welfare’s Grand Challenge to ensure healthy development for all youth
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 53
Objective: The objective of the innovation is to increase caregiver engagement in help-seeking
activities and support for adherence to treatment recommendations for children and adolescents
with early signs of behavioral or mental distress to better manage mental and behavioral health
and improve adult outcomes.
Aim: To make accessing services for military youth and families mental health more socially
acceptable and easier by establishing a supportive community environment for seeking services
with the early signs of mental illness and family dysfunction.
Approach: A community engagement model is utilized to pose the problem of stigma as a
community vs. individual issue and to inspire a collective response to stigma in the local, and
eventually global, community. The project will be guided by the Health Stigma and
Discrimination Framework in order to move toward an emphasis on the “broader social, cultural,
political and economic forces that structure stigma” (Stangl et al., 2019). The Framework is
intentional in challenging the ‘us’ versus ‘them’ dichotomy and allows for self-reflection and
awareness of biases. The collaborative will provide education, training, consultation and
navigation assistance to those seeking to address a mental health concern.
The approach is guided by Social Learning Theory (Bandura), particularly the idea that
behavior change can come about by the addition of new environmental stimuli, such as education
regarding mental illness in youth and the impact of stigma to include implicit bias and automatic
stigma, which are identified as more subconscious forms of stigma. The explicit theory of
change is that if we educate and empower the public about mental health associated stigma, more
youth will engage in needed care earlier; thus, disrupting the development of significant
psychosocial impacts, disability, and early death.
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 54
Anti-stigma activities include education, mental health literacy, contact, peer services,
protest and advocacy, legislative and policy change per the National Academy of Sciences
(2016). These activities will guide all collaborative activities to ensure to goal of stigma
reduction remains the primary focus of the activities.
Targets:
Decrease Stigma: The primary goal of the collaborative will be to address the multiple forms of
stigma that youth and their families are likely to encounter that function as a barrier to accessing
and effective engagement with treatment interventions through education on mental illness,
health and well-being; increasing mental health literacy to better understand mental illness, the
availability of effective treatments, and how to access care for self and loved ones; the promotion
of inclusion and contact with those with lived experience with mental illness; as well as
advocacy activities.
The collaborative should take a stand in addressing stigma in the lay community, but also
in the professional community to include mental health providers; primary care, pediatric,
emergency room, and other medical care providers; teachers, school administrators and staff; and
other community partners who serve mutual consumers and beneficiaries by addressing overt
forms of stigma such as public and courtesy stigma, but also the more subtle forms of stigma
such as implicit bias and automatic stigma that shows up as stereotypes, prejudice, bias, and
discrimination. These activities are likely best framed as opportunities to increase competency in
dealing with a diverse consumer base and to encourage effective use of community resources
offered by organizations and agencies.
Improve Service Delivery and Utilization: The secondary goal of the collaborative is to promote
effective service delivery and utilization through the education and training of professionals and
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 55
community stakeholders; identification and assistance with gaps in service delivery and access
via peer mentoring and navigation partnerships; as well as advocacy for policy changes when
indicated. These activities should be done with the knowledge that barriers can be structural,
logistical, and even psychological.
This target is likely to require changes on the part of professional community
organizations and allowances by consumers to be willing to take a chance to engage. We must
make accessing services easier, less intimidating and more welcoming to truly engage those who
would benefit from the help offered.
Key Activities:
Champion Advocacy and Assistance Training: The collaborative will support the training and
development of community-based assets who empowered to respond to stigma and assist in
navigation of community-based and specialty behavioral health and social services resources.
Champions are individuals that live in the community and are trained to provide accurate
information about mental illness, particularly in children and adolescents, and how to access
services in a supportive, non-judgmental manner. The Mental Health First Aid training offered
Community
Collaborative
Schools
School
Behavioral
Health
Child,
Adolescent,
and Family
Behavioral
Health Service
Child Youth
Services
Army
Community
Services
Department of
Behavioral
Health
Army
community
members
Army Youth
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 56
by the National Council for Behavioral Health is the current gold standard and should be
leveraged by the collaborative for implementation in the community. The collaborative program
will sponsor the training of program staff and exceptionally qualified community members to
become instructors with the commitment to provide quarterly trainings in the community.
Champions are community partners who act in an informal, volunteer capacity in order to
help address stigma in the community and help direct other community members to locally
available services and resources, decreasing barriers and opportunities to deter participation.
Thus, the champions serve both the goal of decreasing stigma and improving service utilization.
Community Conversations: Because addressing an issue as pervasive and complex as stigma
requires multiple avenues, hosting “Community Conversations” is an essential activity with the
intent to increase awareness of mental illness in childhood and adolescence and the impact on
help-seeking behavior and treatment adherence that can significantly impact youth outcomes and
family functioning.
“Community Conversations” are to be facilitated by both a professional and a community
partner on topics that are of interest to the community. They should be hosted in an easy to
access location such as housing community center, a school, the USO, or a chapel and special
care should be taken to ensure a welcoming atmosphere with considerations for childcare and/or
family activities such as dinner and bedtime. The gathering is recommended to last 60-90
minutes with written material to support information shared.
Specific content will be considered in the context of the advisory board/collaborative and,
once scaled, the specific community/sub-community adopting the model. Sources of evidence-
based trainings include material from NAMI and SAMSHA.
Examples of topics might include:
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 57
• Psychoeducation on child development and mental illness
• When and how to access professional care for youth mental well-being
• Teaching emotional regulation to your children (likely a sub-series)
• Impact of trauma on development and health
Network: Establishment and operationalization of a “no wrong door”, network approach to
accessing mental/behavioral and social services, which have the power to alleviate numerous
stressors, within a local community wherein local community-based mental/behavioral health
and social services collaboratively address the psychological and social needs of those who
access the collaborative. The collaborative program staff and volunteers will offer navigational
and short-term case management services to facilitate appropriate and timely resource referrals
and care on an as needed basis. They will also facilitate inter-community networking and
education opportunities in collaboration with various agencies and resources.
Proof of Concept: Stakeholder input was sought in a variety of ways to include formal and
informal interviews and surveys with professionals, non-clinical professionals, Active Duty
Service Members and civilians, males and females, though most were college educated, at least
to the baccalaureate level. Feedback included the belief that stigma is mostly a community
problem that appears to have lessened over time. One Service Member wrote the following,
used with permission:
“My wife and I currently have two teenage children who are involved in counseling for various reasons. I
am active duty military and have been away from my family a lot over the past 18 1/2 years. Being in for
as long as I have I fell into the culture of, if you can’t handle something and need to seek a therapist
you’re weak. Unfortunately, I allowed that stigma to control decisions at home regarding my children. I
always said a certain activity or behavior was a phase, or they’re just being lazy. Luckily, I wasn’t the end
all be all in the decision-making process. After talking for some time to me about issues, and markers for
issues one of our children was exhibiting, I agreed to counseling for them. I said it was a trial basis and
I’d wait and see. It’s now been several years and the difference it’s made is noticeable day in and day out.
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 58
The behavior change and way they go about things is refreshing. It caused me to take a long hard look at
how I viewed mental health issues and the help needed for them. Our second child in counseling started
so they’d have someone they felt they could talk to without being judgmental and a third-party sounding
board. I believe this has helped them as well in dealing with stress, and possibly even preventing
recurring and damaging behaviors. If asked even five years ago if I thought there were real benefits of
children getting help for issues like this I would have been highly skeptical, now, however, I am a firm
believer that the earlier we as parents can identify an issue/potential issue and get our children the help
they need, the better off they will be. “
Evaluation
The primary approach for program evaluation employs the Toolkit for Evaluating
Programs Meant to Erase the Stigma of Mental Illness from Patrick Corrigan from the Illinois
Institute of Technology guides the evaluation of the proposed program. It includes empirically
tested measures in regard to public stigma and self-stigma and are primarily designed to measure
attitudes.
Public Stigma.
There are three versions of the Attribution Questionnaire: a 27-item version (AQ-27), a
nine item (AQ-9), and a short form for children (AQ-8-C) and were developed to measures nine
stereotypes about people with mental illness: blame, anger, pity, help, dangerousness, fear,
avoidance, segregation, and coercion. A fourth measure is the Family Questionnaire (FQ), a 12-
item measure, which looks at public stereotypes about family members of people with mental
illness.
Self-Stigma.
The Self-Stigma of Mental Illness Scale (SSMIS) assesses Awareness, Agreement,
Application, plus Hurt, recognized as four constructs of self-stigma, where are the Recovery
Assessment Scale (RAS) is used to focus on the positive aspects of recovery. Five factors are
considered: personal confidence and hope; willingness to ask for help; goal and success
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 59
orientation; reliance on others; and not dominated by symptoms. The innovator is working to
schedule a table top exercise or focus group with known social contacts on the installation.
Level of Familiarity.
According to Corrigan, research shows that people who are more familiar with mental
illness are less likely to engage in stereotyping. The Level of Familiarity Scale in an eleven-item
instrument that approximates the level of familiarity for the participant.
Program evaluation has been designed to look at engagement with the community,
changes in attitude, and also changes in behavior. While "output" generally measures what the
agency is doing, it is important in this context to understand what and how the community is
interacting with the collaborative, i.e. more contacts is likely an indicator of change in the
community.
Budget
The program is based on the employment of one program supervisor and three education
and outreach workers. The program supervisor should be clinically licensed and have sufficient
experience in providing clinical mental health services that he or she is able to be a source of
consultation for the workers and is able to speak knowledgeably about clinical aspects of care
and mental illness. The three education and outreach worker positions would be well-served if
filled with master’s level social workers. Social workers are proposed due to their unique
dedication to social justice, equality and community work. They are also trained to work on both
a micro and macro level, essential to the proposed work. “Beacon” is the name ascribed to the
community-based assets (volunteers) that have been trained in a modality such as Youth Mental
Health First Aid and Mental Health First Aid, as well as local community resources. They are
trained to engage people authentically at a neighborhood and community level. Volunteers are
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 60
often limited to those who do not need to work and students who are gaining experience for
academic or professional requirements; thus, it is important to consider the need for robust
training and retention effort.
Other expenses include office related costs including rent, office furniture, as well as technology
and communications costs. The program would be best delivered at the Installation’s Army
Community Services (ACS) office due to the long-standing presence in the Army community
and co-location and collaboration with multiple post resources. Program delivery costs include
marketing, materials and supplies, travel and transportation costs, and training.
Sustainability
The proposal is for an ongoing program to address the mental health and psychological well-
being of Service Members and their dependents and to move toward a universal prevention effort
across the Army. The initial year will be focused on establishing a presence in the community,
building professional network relationships on the installation and in the surrounding
communities, and iterating on the work to be done with all stakeholders, while beginning to roll
out proposed test programing for evaluation. Information will be gathered in regard to best
Expenses
Personnel/Salaries
Program Supervisor 89,000 Master's level social worker (clinical) - GS-13
Education and Outreach Workers (3) 155,000 Master's level social workers (non-clinical) - GS-9
Benefits 73,200 30% of salaries
Total Personnel Expenses 317,200
Operating Expenses
Rent 24,000 space rental (2,000/month)
Furniture 30,000 desks, chairs, table
Technology & Communications 24,000 laptops (4)/ cell phones (4) (2,000/month)
Marketing, Material and Supplies 30,000 copies, refreshments, incentives and promotional items (2,500/month)
Travel/Transportation 24,000 mileage/training travel expenses (2,000/month)
Training 20,000 Mental Health First Aid and Youth Mental Health First Aid (x4)
Volunteer related expenses 30,000 training, recognition, and appreciation
Total Operating Expenses 182,000
Total Expenses 499,200
Year One Line-item Budget
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 61
opportunities and method to conduct education and outreach, which will help to refine future
efforts to engage meaningfully in the community, as well as the effectiveness of the selected
interventions to assist in continue program planning. Efforts in subsequent years will focus on
increasing effectiveness and efficiency, as well as engaging in participatory research to help
establish the intervention as an evidence-based practice for stigma reduction in communities.
Recommended Steps for the Formation of a Community Collaborative:
Phase I
1. Create a working group that consists of interested consumers and stakeholders, both on
and off post, from community-based mental health providers, primary care providers,
educators, social service agencies, etc. with special attention to ensuring representation
from racial and ethnic minorities, youth, and those with lived experiences**. The
purpose of this group is to assist with information gathering locally via informal contacts
and, moving forward, more formal setting such as focus groups. This group will begin
the work of beginning dialog about the problem of stigma in the community as a sort of
litmus test.
Key question: How does stigma operate in our particular community, and how do we
bring awareness and voice to this wicked social problem?
2. Develop a formal advisory group with demographics as mentioned above, and the ability
to commit to a higher level to ongoing collaborative sustainment**.
Key question: Who needs to be “at the table” to make meaningful changes to our
community with regard to the problem of stigma? How do we engage them?
**This includes members of the community – laypersons (such as parents, grandparents,
siblings, those with lived experiences, youth and peers) and community professionals
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 62
(mental health providers, primary care and specialty clinics, school staff, clergy and
church staff), and other interested community members as there are no specific
“membership” requirements.
3. Focus on building capacity of the collaborative through the establishment of formal
Memorandums of Understanding (MOUs), training of community champions, and
preparation of marketing and social media presence to promote collaborative activities.
Consider a partnership with a local agency for a limited amount of in-kind work in the
area.
Key question: What kind of formal structure is needed to successfully operate the
collaborative as envisioned for our community? Who can support our endeavors to
establish a collaborative?
4. Conduct a community needs assessment to help understand what the community believes
would be helpful and to develop initial program plans and activities.
Key question: What does the community say with regard to what is needed to make this
change? How do we honor their feedback and encourage continued engagement?
Phase II
5. Begin to rollout program activities that correspond to expressed needs of the community
and professional assets in the community.
Key questions: Are we meeting the needs of all consumers and stakeholders to some
degree with our initial efforts? Are activities aligned with the goal of decreasing stigma
(education, mental health literacy, contact, peer services, advocacy or protest)? Does
this activity help promote effective engagement with treatment and other community
resources aimed at alleviating psychological and social suffering?
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 63
6. Evaluate effectiveness of components and whole program by considering not only
outputs, but also anticipated immediate outcomes. Recommend the use of Corrigan’s
Toolkit for Evaluating Programs Meant to Erase the Stigma of Mental Illness
(https://www.montefiore.org/documents/Evaluating-Programs-Meant-to-Erase-the-
Stigma-of-Mental-Illness.pdf
Key question: Are we doing what we said we said we would do? Are we making changes
to the community’s knowledge and understanding of stigma, mental illness, and
treatment? How do we now this?
7. Make modifications with the input of the advisory group and community feedback
Key questions: What changes do we need to make to stay consistent to what consumers
and stakeholders identify as meaningful? Do we need to make any changes to remain
aligned with initial goals of the collaborative? Do the goals need to be revisited? Are
we on track to make meaningful change?
Phase III
8. Rollout second generation program activities based on feedback and advice of formal and
informal stakeholders.
9. Re-evaluate and make modifications to ensure community and programmatic alignment
to meaningful change.
Phase IV
10. Continue process of innovating, assessing, and documenting efforts to subdue the wicked
problem of mental health stigma and the effects on the American public, and the military
population specifically. Consider publishing and promotion of the model to diffuse
MENTAL HEALTH ADVOCACY AND NAVIGATION PARTNERSHIPS 64
innovation across all military installations and encourage national promotion and
adoption as a best practice in local communities.
Conclusion
Mental illness and stigma are significant issues in America, and our military communities
are not exempt. As our understanding of mental illness and, conversely, wellness, evolves, so
must our efforts to address the issues contributing to and stemming from the complex issues.
The proposed Mental Health Advocacy and Navigation Partnerships program represents an
innovative solution designed the disrupt the norm of waiting for a crisis to seek mental health
help for our military children and adolescents, which will contribute to improved individual and
family functioning, as well as mission readiness. We have an opportunity to come together as an
Army community to create a collective response to the wicked problem of mental health stigma
and improve the health of the community.
Questions can be addressed to Daffney Kubler-Hoffman, DSW Candidate, LSCSW at
kublerho@usc.edu or via telephone at 254-291-4183.
Abstract (if available)
Abstract
Mental health is a significant problem in the United States and abroad, with depression identified as the number one cause of disability in the world. One in five American children and adolescents have a diagnosable mental or behavioral health condition, and only a fraction of youth in need of care are engaged in treatment (Mental health by the numbers, n.d.). Public stigma, self-stigma, and label avoidance are identified as significant psychological barriers to accessing care (Corrigan, 2004). Military youth dependents are at risk to experience a number of life stressors due to their affiliation with the military community related to deployments and reintegration, frequent moves, and overall stressors for military families (Huebner, 2019). Children and adolescents lack the knowledge and agency to seek and engage in therapeutic interventions, thus must rely on informed, empathetic, and empowered caregiver decision makers. The proposed program will create collaborative relationships with multiple community resources, formal and informal community leaders, and other significant stakeholders to educate, equip, and empower decision makers in early identification and intervention in youth mental illness. The program will be responsible for delivering anti-stigma programming to and, most importantly, with the community while also functioning as a one-stop navigational assistance shop as it relates to mental health resources in the larger community in collaboration with community-based resources.
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University of Southern California Dissertations and Theses
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Asset Metadata
Creator
Kubler-Hoffman, Daffney JoAnne
(author)
Core Title
Mental health advocacy and navigation partnerships: the case for a community collaborative approach
School
Suzanne Dworak-Peck School of Social Work
Degree
Doctor of Social Work
Degree Program
Social Work
Publication Date
12/18/2019
Defense Date
11/22/2019
Publisher
University of Southern California
(original),
University of Southern California. Libraries
(digital)
Tag
community engagement model,OAI-PMH Harvest,stigma,youth mental health
Language
English
Contributor
Electronically uploaded by the author
(provenance)
Advisor
Manderscheid, Ron (
committee chair
), Islam, Nadia (
committee member
), Lee, Nani (
committee member
)
Creator Email
adhoffman94@yahoo.com,kublerho@usc.edu
Permanent Link (DOI)
https://doi.org/10.25549/usctheses-c89-259119
Unique identifier
UC11673435
Identifier
etd-KublerHoff-8104.pdf (filename),usctheses-c89-259119 (legacy record id)
Legacy Identifier
etd-KublerHoff-8104.pdf
Dmrecord
259119
Document Type
Capstone project
Rights
Kubler-Hoffman, Daffney JoAnne
Type
texts
Source
University of Southern California
(contributing entity),
University of Southern California Dissertations and Theses
(collection)
Access Conditions
The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...
Repository Name
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Repository Location
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Tags
community engagement model
youth mental health