Alternatives Program Alternatives Program 2-yr Report2-yr Report

Damon Eaves, LCSWDamon Eaves, LCSW

Program IntroductionProgram Introduction• 2003 City & County awarded 2-yr. 2003 City & County awarded 2-yr.

CA. Dept. of Mental Health grant to CA. Dept. of Mental Health grant to “develop alternatives for institutions “develop alternatives for institutions for mental disease treatment.”for mental disease treatment.”

• 2 counties awarded Grants2 counties awarded Grants

• Our Primary focus: African-American Our Primary focus: African-American males.males.

African-American African-American Focus?Focus?

• 2002 report 2002 report ““Identifying factors that contribute to longer Identifying factors that contribute to longer

term community tenure for L-facility term community tenure for L-facility discharged clients (2002)discharged clients (2002)

2001-2002 Census figures show African-2001-2002 Census figures show African-Americans are:Americans are:

• 7% of population is African-American7% of population is African-American• 23% of Adult System of Care23% of Adult System of Care• 28% of residents in IMD’s28% of residents in IMD’s• Stay 20% (152 days) longer than non-Af-amStay 20% (152 days) longer than non-Af-am• More likely to return 6 months post dischargeMore likely to return 6 months post discharge

Program FoundationProgram Foundation• Bottom Line:Bottom Line: Rarely is anyone in an inpt. or a

locked facility because of their mental illness. Rather, it’s their behavior.

• Mission:Mission: all of our programmatic elements need to be structured as innovations to target/change/and resocialize individuals and support their positive behavioral changes & We will discover Black culture

• Admin. Agenda:Admin. Agenda: Meet all requirements, get a budget & have enough left over to make it work.

• Recruitment:Recruitment: Do not rely on system choice/Dumping

Conglomeration of Risk Conglomeration of Risk FactorsFactors

• Primary issue is Primary issue is 80-95%80-95% due to social due to social service/family failures, disparity, inequality & service/family failures, disparity, inequality & ineffective responses. (for all race clients). ineffective responses. (for all race clients).

• Risk Factors:Risk Factors: When You interview, you will find: When You interview, you will find:– Foster CareFoster Care; Sexual Abuse; ; Sexual Abuse; HomelessnessHomelessness; ;

Drug Addiction; Drug Addiction; Family SeparationFamily Separation; ; Incarceration; Incarceration; Trauma/Violence/Physical InjuryTrauma/Violence/Physical Injury; ; Medical Complications; Medical Complications; HomelessnessHomelessness; ; Abandonment; Abandonment; Temporal Impairment (no Temporal Impairment (no future);future); Dysfunctional Communities; Dysfunctional Communities; Incompetent FamiliesIncompetent Families; Learning Disabled; ; Learning Disabled; Environmental HazardsEnvironmental Hazards; Unemployment; Unemployment

ClientsClientsEngagement, Successes, Setbacks:

B.w. (Housing,Weight Loss, Blackhawk, 290 Reg.)E.C. (Engagement, Vallejo, Housing, Residential tx. SHA)D.M.i: (DM Zyprexa, Africa, Crack, Money Mgmt. Meal Purchase))A.N. (can’t hear $, crack)L.A. (met couple at airport, College Committee, Program Housing)E.B. (Zyprexa,Child Molester, Zillionaire)B.B. (bro at SFGH, hygiene, meth iv)J.C. (crack baby, lies, drawing, Asperger’s)M.E.(songwriter, $$, housing, haldol, ran off)A.P. (haircut resistance, field trips, sense of humor)I.M. (attacked police car, crack, seroquel, arrested)W.P, (Wig, 40k & a Cadillac, Soledad Brothers, married.kids, etc)H.T. (knocked over old man; did anything come through?)C.V.W.(stable, wheelchair, brain damage (dog))D.T.(would wander off, family didn’t want in PES, cats have sharp teeth,

rat “delusion”)

Group Types & Cultural Group Types & Cultural AdvantagesAdvantages

• 7 types of groups +special event per month7 types of groups +special event per month• Pre-vocational/Vocational GroupPre-vocational/Vocational Group• Black History GroupBlack History Group• Medication/Health GroupMedication/Health Group• Spirituality GroupSpirituality Group• Black Culture Field Trips Black Culture Field Trips • Health & FitnessHealth & Fitness

• Group Therapy Advantages with African-AmericansGroup Therapy Advantages with African-Americans• MilieuMilieu• MentorshipMentorship• Informal Style (worker & client disclosure)Informal Style (worker & client disclosure)• Direct Observation of clientsDirect Observation of clients• Relationship building among group membersRelationship building among group members• Semblance to African culture (family, group, clan)Semblance to African culture (family, group, clan)

Program Innovations Program Innovations #1#1

• MentorshipMentorship• Breakfast M-F & Meals, (2-3 a week)Breakfast M-F & Meals, (2-3 a week)• Black History LibraryBlack History Library• Open Door PolicyOpen Door Policy• Vocational ProgramVocational Program• Health & Nutrition Initiative/Weight LossHealth & Nutrition Initiative/Weight Loss• Integration with Primary CareIntegration with Primary Care• Food BankFood Bank• Housing (every possible way) SRO, TLC, S+C, SHA, B+C, Housing (every possible way) SRO, TLC, S+C, SHA, B+C,

Family, Girlfriends, etcFamily, Girlfriends, etc• IMD’sIMD’s• Primary Assessment Criteria:Primary Assessment Criteria: Do they look normal-ish Do they look normal-ish• Primary Discharge Criteria:Primary Discharge Criteria: Do you want to work with us? Do you want to work with us? • Interview them, interview staff, contact family and begin Interview them, interview staff, contact family and begin

integration pre-discharge.integration pre-discharge.

Program Innovations Program Innovations #2#2

Vocational Program modificationVocational Program modification – No actual budget for the programNo actual budget for the program– Vocational monies used for Vocational monies used for

• Subsidized bus pass program (disabled passes)Subsidized bus pass program (disabled passes)• Field Trips, Movie Tickets, Admission, Barbering, Field Trips, Movie Tickets, Admission, Barbering,

Fresh ProduceFresh Produce• Pre-vocational training (6 sessions $5/hr.) & Pre-vocational training (6 sessions $5/hr.) &

VocationalVocational• CVE Previous relationship was $12,000 to get our CVE Previous relationship was $12,000 to get our

clients to “2clients to “2ndnd step”(contract in existence) step”(contract in existence)• Cultural Celebrations: Kwanzaa, MLK day, Black Cultural Celebrations: Kwanzaa, MLK day, Black

History Month, Juneteenth, etcHistory Month, Juneteenth, etc• Cooperation with law enforcement for decompensationCooperation with law enforcement for decompensation• Contact and release preparation work in IMD’s Contact and release preparation work in IMD’s

(Cooperation)(Cooperation)

I.D.E.A. Consulting I.D.E.A. Consulting FindingsFindings

I.D.E.A.I.D.E.A.

••Both programs have been Both programs have been highly highly effectiveeffective at reducing the total cost of at reducing the total cost of services to these individuals. (other services to these individuals. (other program male/female, all races)program male/female, all races)

••In comparing seven months of services In comparing seven months of services prior to enrollment into the program with prior to enrollment into the program with seven months following enrollment… San seven months following enrollment… San Francisco saved over Francisco saved over $450,000$450,000 ( at 1 yr. ( at 1 yr. 13 clients).13 clients).

Medications & Af-Am’sMedications & Af-Am’sALL medications have side-effects. Sometimes the ALL medications have side-effects. Sometimes the

side-effect is the medication. (Antipsychotics)side-effect is the medication. (Antipsychotics)African Americans have…African Americans have…

• Higher risk for disease, injury, death & disabilityHigher risk for disease, injury, death & disability• Older population, longer exposure to Older population, longer exposure to

typicals/primary care complicationstypicals/primary care complications• 1.7 times as likely to have DM, death rate 27% 1.7 times as likely to have DM, death rate 27%

higher, and more likely to experience greater higher, and more likely to experience greater disabilitydisability

• 60% more likely to become obese (higher BMI at 60% more likely to become obese (higher BMI at baseline)baseline)

• twice as likely to develop TD than Caucasianstwice as likely to develop TD than Caucasians• Increased risk of hypertension, stroke, heart Increased risk of hypertension, stroke, heart

failure, and kidney disease.failure, and kidney disease.

What is Schizophrenia? What is Schizophrenia? Psychosis?Psychosis?

• Problematic Dx. Of SchizophreniaProblematic Dx. Of SchizophreniaFreud - Dementia Praecox Freud - Dementia Praecox EtiologyEtiologyShared Symptoms?Shared Symptoms?Objective Diagnostic Criterion?Objective Diagnostic Criterion?““Schizophrenias”Schizophrenias”Lack of inclusion ofLack of inclusion of effect of social disparities: effect of social disparities:Cultural/Social/Economic Impacts; Over & Mis DiagnosisCultural/Social/Economic Impacts; Over & Mis Diagnosis

• Extinct DSM DebateExtinct DSM DebateMultiple formats existed. Other formats perhaps more Multiple formats existed. Other formats perhaps more culturally relevant. culturally relevant. Stigma: described vs. defined. Stigma: described vs. defined. Ambiguity has been (falsely) “eliminated”.Ambiguity has been (falsely) “eliminated”.

Race,Ethnicity & PowerRace,Ethnicity & PowerE. Pinderhughes, MSWE. Pinderhughes, MSW

• Client/Worker commonality Client/Worker commonality • Due diligence vs. “Teaching”Due diligence vs. “Teaching”• Advantages & Disadvantages of same race therapistAdvantages & Disadvantages of same race therapist• Dimensions of TrustDimensions of Trust (competence & racism) (competence & racism)• Af-Am Clients Af-Am Clients Tendencies:Tendencies:

• May Push “Boundaries” May Push “Boundaries” • Require an Informal StanceRequire an Informal Stance• Ask for therapist Values, Backgrounds or OpinionsAsk for therapist Values, Backgrounds or Opinions• Attempt to Discern CompetenceAttempt to Discern Competence• Will not engage if Judged or Viewed NegativelyWill not engage if Judged or Viewed Negatively

• Continuum of Culture:Continuum of Culture: Denial-Acceptance- Denial-Acceptance-EmbracingEmbracing

Counseling & Therapy Counseling & Therapy ApproachApproach

• Directive ApproachDirective ApproachAgenda setting, advice, opinions (sensitive and well-Agenda setting, advice, opinions (sensitive and well-timed)timed)

• Focus on Problematic BehaviorsFocus on Problematic BehaviorsMaintain Community LivingMaintain Community LivingDirect ConfrontationDirect Confrontation

Crisis Response/OutreachCrisis Response/Outreach

• Search for Meaning and MetaphorSearch for Meaning and Metaphor““Poetically Camouflaged Language”Poetically Camouflaged Language”Believe it, Don’t act on it. (delusions, fantasies, Believe it, Don’t act on it. (delusions, fantasies, psychosis, narcissism,etc)psychosis, narcissism,etc)Underlying themesUnderlying themesGroups elicit material on various subjectsGroups elicit material on various subjects

A Brief History of A Brief History of PharmacologyPharmacology

• Mood Stabilizers:Mood Stabilizers: March 28, 1948 Lithium Treatment March 28, 1948 Lithium Treatment BeganBegan

• Antipsychotics “discovered”:Antipsychotics “discovered”: developed in 30’s, developed in 30’s, 40’s & 50’s as antihistamines. (noted depressant side 40’s & 50’s as antihistamines. (noted depressant side effects)effects)

• Thorazine:Thorazine: 1950-51 Henri Laborit (France) first used 1950-51 Henri Laborit (France) first used ChlorpromazineChlorpromazine““The patients seemed to become totally indifferent to The patients seemed to become totally indifferent to their surroundings” their surroundings”

• Anti-Depressant:Anti-Depressant: 1950 first anti-depressant 1950 first anti-depressant (tricyclics)(tricyclics)

• Economic Impact:Economic Impact: By 1955 smith klein made By 1955 smith klein made $75,000,000 on Thorazine.$75,000,000 on Thorazine.

• Pharmaceutical - DSM-IV link:Pharmaceutical - DSM-IV link: “Mad Science” “Mad Science”

Black History/Esteem Black History/Esteem Group TopicsGroup Topics

• Over 200 black themed groups, Over 200 black themed groups, 90min.90min.

• Politics, Culture, History, Biographies, Politics, Culture, History, Biographies, Current Events, etc, etcCurrent Events, etc, etc

• What did we talk about?What did we talk about?

U.S. Institutional U.S. Institutional Racism Racism

1619-18651619-1865• 1441-1492-1528-16191441-1492-1528-1619 first Slaves Arrive in America first Slaves Arrive in America• 157 years later, 157 years later, Declaration of IndependenceDeclaration of Independence. Jefferson’s . Jefferson’s

condemnation of British participation in the slave trade. condemnation of British participation in the slave trade. “All men created equal.” ?“All men created equal.” ?

• 17871787 U.S. Constitution.U.S. Constitution. 3/5ths clause; 20 yr. Ban on 3/5ths clause; 20 yr. Ban on congress; fugitive slave clause; govt. power to put down congress; fugitive slave clause; govt. power to put down slave insurrectionsslave insurrections

• 17911791 Bill of Rights ( Blacks Excluded, not citizens) Bill of Rights ( Blacks Excluded, not citizens)• 18571857 Dred Scott; blacks are not citizens, so they can not Dred Scott; blacks are not citizens, so they can not

sue in court.sue in court.• 1865 1865 Black Codes; employed, movement, speaking, Black Codes; employed, movement, speaking,

virtual slaveryvirtual slavery• Reconstruction:Reconstruction: Tunis Campbell, 40 acres/mule Tunis Campbell, 40 acres/mule• Civil rights Act of Civil rights Act of 1866 & 18751866 & 1875 desegregation. desegregation.

(overturned in (overturned in 18831883 (Harlan dissent). Power given to (Harlan dissent). Power given to states, Whites had the right to discriminate)states, Whites had the right to discriminate)

Institutional Racism Institutional Racism 1866-19911866-1991

• 13th 13th 18651865 (freedom), 14th (freedom), 14th 18681868 (citizenship), 15th (citizenship), 15th amendment amendment 18701870 (vote) (vote)

• 1870-711870-71 Enforcement Acts: protected blacks' right to Enforcement Acts: protected blacks' right to vote, hold office, serve on juries, and receive equal vote, hold office, serve on juries, and receive equal protection of laws. protection of laws.

• 18801880 Strouder v. West (Juries: axe murder) Strouder v. West (Juries: axe murder)• Plessy v. Ferguson Plessy v. Ferguson 1896 1896 (street car), “separate but equal” (street car), “separate but equal”

(Justice Harlan)(Justice Harlan)• Gaines (Gaines (1938,1938, U. Missouri) U. Missouri)• Sweat v. Painter (Sweat v. Painter (19501950 U. Texas) U. Texas)• 19541954 Brown v. Board of Ed (I & II) “with all deliberate Brown v. Board of Ed (I & II) “with all deliberate

speed”speed”• Civil rights Act of Civil rights Act of 1964 1964 Outlawed Segregation (for the 5th Outlawed Segregation (for the 5th

time) renewed time) renewed • Civil rights Act of Civil rights Act of 19911991 (re-affirmed & strengthened) right (re-affirmed & strengthened) right

of recoveryof recovery

Institutional RacismInstitutional RacismFrom Slavery to the From Slavery to the

P.I.C.P.I.C.• Prior to 1865, blacks constituted the minority of inmates,

after 1865, they were the vast majority with convict leasingconvict leasing. 25-45% yearly death rate. 1878, 92% of leased in Georgia were black. – Black are 12%12% of the population and & 13%13% of drug users. In

2001, comprised 38% arrested for drug offenses, 44% prosecuted, 59% convicted, sentences 49% longer (than whites).

– 500%500% rise in incarcerations in last 30 years, 41%41% are Black– Black rate of incarceration more than 6 x’s of whites6 x’s of whites nation-

wide– 1 in 3 Black males destined for prison– Black youth receive life without parole 10x’slife without parole 10x’s over White youth– Powder Cocaine 5 grams5 grams =5 yrs mandatory vs. 500 grams500 grams

powder (over 1 lb.)– Strategic targeting of street level crack usetargeting of street level crack use to ensnare

blacks– Whites vs, Blacks:Whites vs, Blacks: 5x’s cannabis, 4 x’s cocaine, 3x’s crack

[80% vs. 33%]

Institutional RacismInstitutional RacismPropaganda & Propaganda &

ConspiracyConspiracy– Slavery Profit:Slavery Profit: 500 Millionaires/Mansions in Natchez,

Mississippi – Felony Disenfranchisement:Felony Disenfranchisement: voting, Grants, Ed. Loans,

Weapons, Jobs. – Racial Profiling:Racial Profiling: 1996, New York Superior Court, Blacks 5

x’s as likely – Ghetto Creation:Ghetto Creation: 1930’s Redlining, “Little Harlem”; equity– Suspensions/Expulsions:Suspensions/Expulsions: Nationwide, 35% of black

students, grade 7-12 had been suspended or expelled, vs.15% of whites; equal offenses

– ““Gifted”:Gifted”: Yale University showed that Black students 40% less likely to be placed in Accelerated classes, and 2.5 times more likely remedial

– Dropouts to Prison:Dropouts to Prison: In New York City 90% of all male prisoners dropouts.

– CointelproCointelpro:: Polictical Assasination, Illegal Wiretaps, Frame-ups, Domestic Black Ops.

Institutional Racism Institutional Racism cont’dcont’d

Government & Government & AcademicAcademic– Social Security DiscriminationSocial Security Discrimination (domestic and

agricultural exclusion, Benefits age)– 2005 NBFA EWG Report: National Black Farm 2005 NBFA EWG Report: National Black Farm

Workers:Workers: USDA 1997 settlement; USDA admission of denied loand 1982-1996. Black Farm Ownership decreased from 54,367-29,090. $2.3 Billion Award: but as of 2005, 81,000 of 94,000 claims denied, (64,000 filed “after deadline”)only 25% funds distributed. New $20.5 billion suit currently pending.

– 2003 NAACP Report:2003 NAACP Report: Normal Af-am boys dx. With mental disorders; 11 times more likely to be placed on adhd, psychosis, depression meds; 32% of mild retardation are Af-am; netherlands report, 62% significant improvement in diet change within 3 weeks.

– GRE, ACT, SAT: GPA; Gratz & Grutter Decision:GRE, ACT, SAT: GPA; Gratz & Grutter Decision: No challenge to lower scoring White Students

RecommendedRecommended• ROBERT F. WILLIAMSROBERT F. WILLIAMS:: Radio Free Dixie, -

Tyson• OLAUDAH EQUIANOOLAUDAH EQUIANO:: The Interesting

Narrative of the life of Olaudah Equiano• MALCOLM XMALCOLM X:: The Autobiography of Malcolm

X -Alex Haley• FREDERICK DOUGLASSFREDERICK DOUGLASS:: My Bondage, My

Freedom• SOLOMON NORTHRUPSOLOMON NORTHRUP:: Twelve Years A Slave