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Bright Futures for Women’s Health and Wellness Initiative
Supporting Statement Appendices

Table of Contents

APPENDIX A: A WOMAN’S GUIDE TO EMOTIONAL WELLNESS ...................................................... A-1
APPENDIX B: A YOUNG WOMAN’S GUIDE TO EMOTIONAL WELLNESS ....................................... B-1
APPENDIX C: DATA COLLECTION INSTRUMENTS AND DATA TO BE COLLECTED................. C-1
APPENDIX D: EVALUATION QUESTIONS AND INDICATORS FOR THE BRIGHT FUTURES FOR
WOMEN’S HEALTH AND WELLNESS EMOTIONAL WELLNESS CONSUMER GUIDES .............. D-1
APPENDIX E: CONSUMER SURVEY............................................................................................................... E-1
APPENDIX F: CONSUMER INFORMED CONSENT FORM ...................................................................... F-1
APPENDIX G: DISTRIBUTOR SURVEY ........................................................................................................ G-1
APPENDIX H: FOCUS GROUP GUIDANCE ................................................................................................. H-1
APPENDIX I: SAMPLE EVALUATION REPORT #1...................................................................................... I-1

Appendix A:
A Woman’s Guide to Emotional
Wellness

A-1

Bright
Futures

A woman’s guide to emotional wellness
Bright Futures for Women’s Health and Wellness

Welcome!
Thank you for taking the time to read "A Woman’s Guide to Emotional Wellness." This booklet is part of a series of
materials called "Bright Futures for Women’s Health and Wellness." This series also includes guides for young women,
community organizations, and health care providers. These materials were developed by the U.S. Department of Health
and Human Services, Health Resources and Services Administration, Office of Women’s Health, with the guidance of a
10-member panel of predominantly female mental health experts (medical doctors, psychiatrists, and researchers) from
across the country. The aim of the Bright Futures project is to help women achieve better physical, mental, social, and
spiritual health by encouraging healthy practices.
Like physical health, mental health exists on a spectrum. At one end are feelings of flourishing and thriving, and at the
other are depressed and anxious feelings. For a variety of reasons, the field of mental health has historically focused on
the negative end of this spectrum. This booklet is different. It is not about treating or avoiding depression: it is about
helping women like you to feel your best.
The tips and information in this booklet are drawn from the latest research into what helps women excel in their day-today lives. This research suggests that coping skills (such as flexibility, feeling strong, and optimism), personal traits (high
self-esteem), and resources (spiritual practices and support from family and friends) can boost women’s mental
wellness. As women develop these elements in their own lives, they increase well-being, satisfaction, and their overall
quality of life. While this guide focuses on women’s emotional wellness, it also touches on some of the more common
types of depression and anxiety that many women can face from time to time. It is not intended, however, to help you
diagnose or treat these or other illnesses. If you believe you are suffering from depression, anxiety, or a more serious
mental illness, please see a health care professional who can help you.
This guide is designed to share this information with you and to encourage you to adopt some of the tips to improve
your emotional wellness. We hope you find it helpful. When you are finished with it, please share it with the other
women in your life!
Sincerely,

Elizabeth M. Duke
Administrator
Health Resources and Services Administration
U.S. Department of Health and Human Services

Table of Contents
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
APPRECIATING YOURSELF . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Build your self-respect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Build your self-confidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Build your self-esteem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Set your own goals and self-expectations . . . . . . . . . . . . . . . . . . .
Take care of your body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Think positively . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Make time for activities you enjoy and that have meaning for you . . .
Learn skills that help you cope with difficult emotions and situations
Activities to help you appreciate yourself . . . . . . . . . . . . . . . . . . . .

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FINDING BALANCE AND PURPOSE . . . .
Self-discovery . . . . . . . . . . . . . . . . . . . . . . .
Developing a personal mission statement . . . .
Setting goals. . . . . . . . . . . . . . . . . . . . . . . .
Adapting to adversity and change . . . . . . . . .
Learning skills that help you deal positively with
Increasing your confidence . . . . . . . . . . . . . .
Nurturing your spirit . . . . . . . . . . . . . . . . . .
Activities to help you find balance and purpose

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CONNECTING WITH OTHERS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Find a connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Identify with your racial, ethnic, or cultural background, and learn about other cultures
Connect with children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Learn about healthy relationships. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Learn about empathy and its importance in relationships . . . . . . . . . . . . . . . . . . . . .
Learn how to be more mindful of other people and their situations. . . . . . . . . . . . . . .
Develop patience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Be safe in relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Give help to others in need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Activities to help you connect with others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
RESOURCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Introduction
You might have heard

or read something recently about emotional wellness. Emotional wellness
means you feel good about yourself, your relationships, and your purpose in life. It does not mean that
you will never be sad, angry, or confused. Everyone will have some of these feelings from time to time.
However, if you are emotionally well, you will have fewer lows and will be able to bounce back from sad
times faster. Emotional wellness also helps you to be happier during the good times.
This guide will give you some of the best tips around to help you live better, become more balanced,
and feel better about your life. Feeling good helps you do better at all your activities each day. Each
woman is unique. We hope that every woman will be able to use some of this information to improve
her emotional health.
The guide has three sections. Each one is important for emotional wellness. These are:

Appreciating Yourself

Finding Balance and Purpose

Connecting with Others

This guide contains many tips. Not all of them may apply to your life right now. However, finding even
one tip that will help you feel better and improve your life is worthwhile. You might also find tips in this
guide that could help your friends or family members.
Remember, it will take time and work to improve your emotional wellness just like any other goal. You
will have both triumphs and setbacks along the way. However, if you are patient with yourself and keep
working at it, you will see improvements over time.
Happy reading!

Section 1:

Appreciating yourself

An important part

Appreciating yourself

of emotional wellness is to value who you are and what you do. Women often have many
roles and responsibilities in their lives. They can be a mother, a daughter, a friend, a leader, a co-worker, a
wife, a partner, a volunteer, a bill payer, a homemaker, and so on – all at the same time. These many roles and
tasks can make women feel overwhelmed.
That’s why it is especially important for women to take time to value themselves and all the things they do.
Taking a little bit of time every day to do that can help you to do a better job at all of your tasks. It also makes
you feel good about yourself!
There are many different ways you could value yourself. This guide outlines some of the most important ones
and gives you tips on how to do it:

Build your self-respect

Build your self-confidence

Build your self-esteem

Set your own goals and self-expectations

Take care of your body

Think positively

Make time for activities you enjoy and that have meaning for you

Learn skills that help you cope with difficult emotions and situations

Section 1:

Appreciating yourself

Build your self-respect
Self-respect is an important part of emotional wellness. Every woman wants to be respected. Have you ever
thought about whether you are respecting yourself? This means taking care of yourself in four different ways:

Physically: Being active, eating healthy foods, getting enough sleep, and practicing good hygiene.

Mentally: Challenging your mind, including learning about yourself and your family history.

Spiritually: Taking time to explore your beliefs about the meaning and purpose of life. Taking time to think
about how you want to guide your life by the principles that are important to you.

Emotionally: Thinking good thoughts about yourself and others.

Every woman can appreciate herself more. The tips in this guide can help you enhance your self-respect.

Debbie’s story: “I’m a mom who works part time and I have two little kids. Last year, there
were so many demands on me I hardly ever took any time for myself. I was exhausted, and I
didn’t feel as good about myself as I used to. My best friend encouraged me to make some
time for myself every day. At first, I thought ‘No way!’ but I decided to try it. I started by taking
a short walk several days a week and trying to go to bed 15 minutes earlier. After I got in the
habit of doing that, I started to use the time when I was driving to pick my son up from
preschool to think about all the good things I do every day. These small steps have really
helped. I still work hard, but I have more energy and feel better. Now I encourage my other
friends to do it, too!”

Section 1:

Appreciating yourself

Build your self-confidence
Feeling self-confident helps you believe that you can try new things. Even if things go wrong, self-confidence helps
you know that you can try to make them better. You can increase your self-confidence by setting goals that
make sense, thinking positively, and being prepared.

Here are some tips to increase your self-confidence:
• Stop comparing: Your abilities and talents are unique and special. Everyone has different
goals in life and ways of thinking about what success means. Decide what success means for
you. Try not to worry about what success means for your neighbor.
• Remember your good deeds: Think about the times when you have made a difference in
someone else’s life. Give yourself credit for the good things you do for others every day.
• Forgive yourself and learn from your mistakes: Everyone makes mistakes from time to time.
Learn from what went wrong, but don’t dwell on it.

Section 1:

Appreciating yourself

Build your self-esteem
Self-esteem is important to your emotional health. A woman with healthy self-esteem knows what makes her
unique. She respects those things in her personality. Self-esteem helps you to feel good about yourself, no matter
what other people think of you.

Tips to help you boost your self-esteem:
• Accept your strengths, and your weaknesses: No one is perfect. Your strengths and
weaknesses are what make you unique.
• Congratulate yourself: Honor your achievements, big and small.
• Encourage yourself and others: Think positive, kind, and loving things about yourself. Let
others know the good things you feel about them.
• Value yourself: Friends and family are great, but don’t depend on others to make you feel
good about yourself. Value yourself no matter what other people say about you.
• Surround yourself with positive, healthy people: Choose friends who value you.
• Turn anger around: Everyone will be angry from time to time. When you get upset, try to
use that energy toward positive goals instead of dwelling on the negative.
• Praise yourself: Remember at least one good thing about yourself every day.
• Do good things: Do at least one thing every day that you feel good about.

Section 1:

Appreciating yourself

Set your own goals and self-expectations
Many women let others tell them what they should be doing and how. To be emotionally well, you need to judge
yourself by your own standards and no one else’s.

Tamika’s story:

“I’m from a big family, and I grew up always comparing myself with everyone
else. I was constantly disappointed because whenever I would get a raise at work, one of my
sisters would, too, or whenever I would learn a new activity, someone else would beat me to it.
But eventually, I started thinking about my life and realized that I was achieving all the things I
wanted to do. It didn’t matter what everyone else in my family was doing: I was leading my own
life and was happy about it. Now, I try not to compare myself with other people anymore, and I
remind myself to feel happy for my siblings when something good happens to them.”

These tips may help you set your own expectations:
• Define beauty for yourself: Images of thin, glamorous women are everywhere. However, most women
do not look that way. True beauty comes from inside and shines outward. Focus on the things about
yourself that you think are beautiful.
• Define your own values: Many women believe they need to live up to the expectations of our culture.
However, the only values you need to live up to are your own. Take a look at your beliefs and values.
Remember how you add value to the world.
• Focus on your strengths: We all have strengths and weaknesses, but many of us focus more on our
weaknesses. Try this trick to change your way of thinking: Each time you think about one of your
weaknesses, follow that with a thought about one of your strengths.

Section 1:

Appreciating yourself

Take care of your body
If you exercise, eat right, and get enough sleep, it will help your physical health. It will help your emotional health
as well. You can improve your mood with physical activity, healthy eating, and getting enough sleep. Enough sleep
will also improve your memory and help keep you healthy. Most women need about 8 hours of sleep a night.
You can learn more about physical activity and healthy eating in “My Bright Future: Physical Activity and Healthy
Eating Tools for Adult Women.” You can download a free copy at www.hrsa.gov/womenshealth.
You don’t have to make a lot of big changes to exercise more, eat better, or get more sleep. In fact, you will do
better if you try to reach your goals in small steps.

Here are some tips to get you started:
• Healthy eating habits: Decide on just one thing you would like to do to eat healthier. Keep
doing it until it becomes a habit. Then try to form another good eating habit. (If you aren’t
sure what healthy eating means, here is one definition: Healthy eating means consuming a
variety of nutrient-dense foods and beverages within and among the basic food groups, while
choosing foods that limit your intake of saturated and trans fats, cholesterol, added sugars,
salt, and alcohol.)
• Physical activity: Add a few minutes of walking or some other form of exercise to your day.
Keep doing it until you have reached your goal. (One goal is to aim for at least 30 minutes of
walking or other moderate physical activity on most days of the week.)
• Set an earlier bedtime: Make your bedtime 10 minutes earlier. Keep doing it until you’ve
reached your goal.
• Develop good sleep habits: Write down your sleep habits for a week and look for ways
to improve them. Once you’ve found the right bedtime, try to go to bed at about the same
time every night. Try not to eat, drink alcohol or caffeinated beverages, or exercise right
before bed.

Section 1:

Appreciating yourself

Think positively
An important part of emotional wellness is training yourself to be more positive or optimistic. While this may not be
easy, positive thinking during tough times will help you stay hopeful. It can improve your chances of moving past
your problems. It also has been linked to better health. Some people are more optimistic than others, but everyone
can learn how to be more positive.

Here are some tips:
• Seek the positive: When things go wrong, look for something positive. For
example, if your friend cancels your dinner plans, look at it as a chance to do
something for yourself. You could choose to read a book or call another
friend instead.
• Focus on the good things: Even when something has upset you in one part
of your life, you can still focus on the things you value in other areas. This
helps you to keep perspective and to cope.

Section 1:

Appreciating yourself

Make time for activities you enjoy and that have meaning for you
One way to improve your overall wellness is to get involved in activities you enjoy and that mean a lot to you. You
can get happiness from simple pleasures and from being active and involved.

Here are some tips to help you make time for these activities:
• Schedule them: Treat activities with your friends the way you would your
work or other appointments.
• Find activities that have meaning to you: Spend your time on issues or
activities that you really care about. You will be more committed to them
and enjoy them more!
• Do things with your friends: Make activities you care about an important
part of what you do with your friends or family.

Section 1:

Appreciating yourself

Learn skills that help you cope with difficult emotions and situations
Coping is the way we handle difficult situations, people, and problems. It is how we survive stress or conflict.
Every woman has her own coping style.
In general, there are three main ways that people tend to cope with stress:

Task-oriented coping: In this coping style, people will take a close look at the situation and take action to
deal directly with the issues.

Emotion-oriented coping: In this style, people feel emotions, express feelings, and tend to ask for help if
they need it.

Distraction-oriented coping: Here people keep themselves busy – distract themselves – in order to take
their minds off their problems.

Once you understand which of these styles you tend to use, you can try other coping styles that may help you
handle difficult situations. Here are some additional tips:

Write it down: Writing down your feelings is a good way to deal with your emotions.

Take care of yourself: Get plenty of rest. Eat healthy foods and be physically active. Stick to your normal
routines, and stay away from risky behavior.

Stay connected to others and share how you are doing: Seek out trusted family members and friends
who can offer support, even over the phone or through e-mail.

Ask for help: If you feel overwhelmed, ask friends, a social worker, a faith-based organization, or your doctor
to find professional help. Strong people know when to seek help. Everyone needs help from time to time.

Section 1:

Appreciating yourself

Activities to help you appreciate yourself
Here are some short exercises you can try to help you learn to appreciate yourself. You can do them by
yourself, or with friends and family members.
Name two things you are good at:

______________________________________________

Name two things about you that you think are beautiful (inside and out):

______________________________________________

Think about what makes you feel good and why you feel good.

Section 1:

Appreciating yourself

Now think about what makes you feel stressed and why you feel stressed.

Section 2:

Finding Balance and Purpose

Finding balance and purpose
An important part

of being emotionally well is finding a sense of balance, meaning, and purpose in
life. This balance and purpose will be different for each woman. However, for most women it may
involve some of the same steps:

Self-discovery

Developing a personal mission statement

Setting goals

Adapting to adversity and change

Learning skills that help you deal positively with stress

Increasing your confidence

Nurturing your spirit

This section gives you advice and tips on how to do each of these things. Keep in mind that finding a
sense of balance and purpose in your life is a journey. It might mean different things to you at different
times in your life, but thinking about these issues will help you to be more emotionally well.

Section 2:

Finding Balance and Purpose

Li’s story: “There have always been so many things I wanted to do in life, but I had a hard time
deciding what to work on first. I would spend a little time on this, a little on that, but I wasn’t
accomplishing any of my goals. One of my co-workers suggested that I take the time to write down
all my goals and then decide which ones were most important and work on those a little bit at a
time. I had a hard time choosing where to start, but when I did, it really helped. I’m not doing as
many things as I used to, but I’m really making progress on what I am doing. And I feel a lot less
stressed out about my life.”

Self-discovery
Self-discovery helps us take a look at our values and dreams so we can be sure we are working toward the right
goals. One way to do this is through writing. Writing not only helps self-discovery, but it also can be good for
your health. Don’t worry about complete sentences or grammar. Just let your thoughts flow from your mind,
through your pen, and onto the paper. If you have a creative style, add drawings and use colorful pens!
Here are some ideas to get you started:

I am happiest when…

I am proud of myself because…

I was born to…

I can simplify my life by living without…

In my dreams, I…

I believe in my abilities to do great things because…

I feel strongest when…

I’m proud of my family or community because…

Section 2:

Finding Balance and Purpose

Developing a personal mission statement
Do you ask yourself, “Why am I here? Who am I? What is my purpose in life?” These are good questions to
ask. The meaning and purpose of life is unique for every woman.
A personal mission statement describes how you want to live your life. One way to develop such a statement is
to imagine your 80th birthday. Think about what all your friends and family would say about you. Write your own
life mission statement, and update it as your life goals change.

Here are two examples of a mission statement:
• Each day of my life, I will work to understand myself better. I will take time to
smell the roses, enjoy simple pleasures, care for my body, nourish my mind,
undertake challenges that come my way, and be proud of those things that
make me unique.
• My purpose is to express my love for life by appreciating the small things,
loving my family, and prioritizing my work. I will welcome each day with a smile.

Section 2:

Finding Balance and Purpose

Setting goals
By setting and meeting realistic goals, your life will have more meaning and purpose. You will have a better
understanding of how to move forward. If you have several goals, list them in order of importance. That helps
keep you from feeling overwhelmed. It also helps you keep your attention on your most important goals.
Remember, setting goals is a lifelong process. Once you have completed one goal, you can start on another!
You can use the following steps to set any personal or professional goal:

Write down your goal: Write your goals in a positive way. For instance, write, “Learn to do well,” not, “Do
not make mistakes.”

Set a deadline for achieving the goal: Make your goals precise. Include dates, times, and amounts so that
you can see how well you are doing.

Know your obstacles: List the obstacles you need to overcome in order to accomplish your goal.

Identify who can help: Write down the names of people and groups you need to work with to reach your
goal.

Identify what you need to know: List the skills, knowledge, and experience required to reach your goal.

Create an action plan: Develop a plan for learning the skills you need to reach your goal.

Know the reason: Write down the benefits of achieving your goal.

Setting goals is important, but make sure your goals are realistic. For instance, if your goal is to get more
sleep, don’t try to go to bed an hour earlier right away. Instead, set smaller goals of going to bed 5 or 10
minutes earlier each night. In other words, take small steps and keep on taking them every day. Celebrating
your small goals along the way will keep you on the road to achieving your larger goals!

Section 2:

Finding Balance and Purpose

Adapting to adversity and change
Resilient people know how to bounce back from hardships and find ways to grow from bad situations. They do well
with change, and they gain strength from misfortune. The good news is that being able to adapt and change can
be learned by focusing on three things:

Outside supports: These include people you trust and resources that make a person feel safe and free to
grow. Know who you trust, and turn to those people in difficult times.

Inner strengths: Another way to help yourself adapt to change is to find the strong points of your
personality and use them. Know your best personality traits such as a positive outlook, kindness, or
confidence. Draw on those traits for strength when you need it.

Learned skills: You can develop skills to make yourself more adaptable or flexible. Know what skills you
need in challenging times and work to develop them when things are going well for you. For example, if you
don’t think you communicate well, ask a friend to help you better express your feelings.

Christen’s story: “When I am feeling overwhelmed and know that I need to give myself
a break, I turn off my phone. I try to slow down a little bit by going for a long walk or
taking a bike ride to clear my head and look at nature. Sometimes, I like to put on my
sweats and slippers and curl up with a good book, or write, draw, or play my guitar –
anything to feed other parts of myself so that I feel re-energized. At times like these, I
draw on my beliefs for comfort and strength.”

Section 2:

Finding Balance and Purpose

Learning skills that help you deal positively with stress
Every woman deals with stress. Some stresses are smaller (like trying to find a parking space when you are in a
hurry), and some are larger (like dealing with a divorce). No matter the size, knowing how to deal with stress is
an important part of being emotionally well.

Here are some tips for dealing with stress:
• Know how you react: Think about how you respond in times of stress or
change. Do you like the way you respond? How can you change it?
• Seek guidance: Ask others – such as friends, faith-based advisers,
counselors, or family members – how they respond to stress. Try what
seems to work well for them.
• Make a plan: Think about how you want to respond to stress. Write down
the names of people you would seek out for help.
• Be ready to change: Think about how open-minded and flexible you are
when it is time for a change. Think about how you can accept change in
times of stress.

Section 2:

Finding Balance and Purpose

Increasing your confidence
Confidence is your belief in your ability to reach your goals. Women who are emotionally well have a strong belief
that they are able to succeed.

Here are three ways you can feel more confident:
• Doing what you do best: The best way to begin feeling more confident is to focus
on the things you already do well. If you don’t know what things you do well, ask
your friends and family. Then focus more of your time on those things, and
congratulate yourself for your successes. This will give you more confidence.
• Seeing others do it: Seeing someone like yourself succeed will help you believe that
you can do it, too. If there is something you have always wanted to do but you are
not sure you can do it, then find another woman who is doing it. Ask her if you can
watch. Then, see if she will help you get started!
• Use your emotions: If you have a hard time starting something, use your emotions
to help you take action. It’s OK to be excited, nervous, or afraid about something
new. Accept those feelings and use them to help you get going.

Section 2:

Finding Balance and Purpose

Nurturing your spirit
It is easy to know when we feel physically tired, but it takes time to know when we
feel emotionally tired. Caring for your spirit is taking a conscious break to renew
the soul. It means taking time to tune out the world and to reconnect with
yourself. Women who take time to nurture their spirits tend to be more
emotionally healthy.
Here are some ideas on how to slow down, turn your focus inward, and
recharge:

Sip a cup of hot tea or hot chocolate, or drink a glass of cold lemonade.

Take a long shower or bath. Pamper yourself.

Write down your thoughts, or express yourself through art or music.

Meditate or pray.

Sit quietly and feel yourself breathe.

Take a break to read a book or magazine.

Take a walk and look at nature. Focus on enjoying the simple beauty of the world around you. Think about
what it means to achieve personal peace.

Use a calendar to organize your time, and write in some time for yourself.

Section 2:

Finding Balance and Purpose

Activities to help you find balance and purpose
Here are some short exercises you can do to help you find balance and purpose in your life. You can do them by
yourself, or with friends and family members.
What is your personal mission statement?
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
How do you manage stress, and how could you do it better?
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
How could you make more time for yourself?

Section 2:

Finding Balance and Purpose

Write down and plan for one of your personal goals:

What is your goal?

When do you want to achieve your goal?

What are your obstacles?

Who can help?

List the skills and knowledge you need to reach your goal.

Make an action plan.

List the benefits of the goal.

Section 3:

Connecting with others

Connecting with others
Women can find many different ways to connect. You can connect to others through your neighborhood, your
ethnic group, a club you belong to, or your group of friends. Connections are an important part of emotional
wellness.

Connections with others can help you have a sense of belonging. Other people can help you find meaning in life
and feel valued. They can benefit your health. Being connected to others can help you fight depression and give
you a better quality of life.
This section of the guide will give you tips on how to form connections and develop and maintain healthy
relationships:

Find a connection

Identify with your racial, ethnic, or cultural background, and learn about other cultures

Connect with children

Learn about healthy relationships

Learn about empathy and its importance in relationships

Learn how to be more mindful of other people and their situations

Develop patience

Be safe in relationships

Give help to others in need

Section 3:

Connecting with others

Find a connection
As humans, and especially as women, we have a deep need to feel connected. Think about your many
relationships: family, friends, co-workers, neighbors, and people you see every day. No matter how close or
casual, those connections are all important. Our connections to others shape our thoughts and feelings. Every
woman needs connections.

Here are some things you can do to feel more connected:
• Volunteer in your neighborhood or community. Check with your local government or local
community organizations for opportunities.
• Pick up a local newspaper and attend an advertised community event with a friend.
• Attend events or take classes at a local community or senior center.
• Sign up for an exercise class.
• Attend a PTA meeting.
• Spend more time with your friends. Make an effort to call and write them more often.
• Accept offers of assistance. Offer to trade favors, such as babysitting or cooking, with others.

Section 3:

Connecting with others

Identify with your racial, ethnic, or cultural background, and
learn about other cultures
Some people may draw strength from their racial, ethnic, or cultural communities. Our racial, ethnic, and cultural
histories tell the stories of where we came from. Taking pride in your heritage is a good way to connect with
others. Along with learning about your own background, a great way to make connections is to learn about the
backgrounds of those around you.

Here are some ways to learn more about your history, or that of those around you:
• Interview a family member or friend.
• Go to a cultural event in your community.
• Research issues related to race, ethnicity, or culture on the Internet or at the library.
You could try to find out more about your last name or family history, or that of a friend
or neighbor.
• Coordinate an ethnic potluck at your workplace.
• Read a book or visit a Web site about your culture, or that of a friend or neighbor.

Section 3:

Connecting with others

Connect with children
Children are an important part of the lives of many women. They could be your own children or grandchildren.
They could be those of a friend or family member, or children you see in your community. Staying involved in the
lives of children can help you build a strong emotional life.

Here are some ways to help you stay connected to the children in your life:
• When talking to children, get to their level. Make eye contact to show them that they are important to
you.
• Ask kids about their schoolwork, their friends, their dreams, and their feelings in general. Share your
thoughts and feelings with them, too.
• Write a note to the children in your life to let them know you care about them and will be there for them.
• When you have to be away from your own children, make certain you stay connected. Call them regularly
when you are away from home, or leave a note of love in a spot where they will find it. Staying connected
is not only good for them, it is good for you, too!

Section 3:

Connecting with others

Learn about healthy relationships
Having connections and a social support system is one of the best ways to improve your emotional health. It
makes you feel good just to be able to talk to friends and family members. The best connections are part of
healthy relationships. Here are a few ingredients for a healthy relationship:

Respect: Value yourself and the other person in the relationship.

Mutuality: Healthy relationships go both ways. Both people give to each other and receive from each other.

Communication: Be able to talk with, and listen to, other people. Share information so others can get the
chance to know you. Ask questions so you can get the chance to know others.

Honesty: Honesty is a sign of respect in healthy relationships.

Trust: In healthy relationships, people earn your trust.

Flexibility: People and situations change. Being flexible keeps relationships strong.

Dependability: Follow through on the things you say you will do. Be a dependable friend.

Additional qualities of healthy relationships are discussed next.

Section 3:

Connecting with others

Learn about empathy and its importance in relationships
Empathy is being able to understand what another person is feeling. It means to “put yourself in someone else’s
shoes.” It is a key part of a strong relationship. Empathy makes people feel listened to and understood. Seek
friends who are empathetic, and learn how to be empathetic.
Here are two steps you can take to show empathy: 1) give a brief reply that captures the situation; 2) add an
emotion.
Suppose a friend tells you how she had to stay late at work and missed an important event. You can say,
“When you could not leave work on time, you must have felt frustrated.” This shows that you are really listening
and trying to understand how your friend is feeling.

Maria’s story:

“Recently, I got into genealogy. It’s fun to learn about all the women in my family and
their histories. It makes me feel really connected with my heritage. I tried to get my best friend into it,
but her parents are divorced and she’s not close with her father’s side of the family. She admitted that
the thought of exploring her family tree both excited and saddened her. I hadn’t even thought about how
hard that might be for her. So, I suggested we just trace her mother’s side of the family as a start and
see what kinds of interesting things we could discover. We had a great time, and I could tell she really
appreciated my sensitivity.”

Section 3:

Connecting with others

Learn how to be more mindful of other people
and their situations
Being mindful means having your mind present in a situation. That means thinking about what is going on and being
aware of your feelings in the moment. A mindful person thinks about and cares about other people’s feelings while also
being aware of her own feelings.

Here are some ways to be mindful:
• Be present: Be aware of your own thoughts and feelings.
• Show respect: Listen to your friends, and really consider their thoughts and feelings.
• Be considerate: Think about the needs of others and help them when you can, even
before they ask for help.
• Rejoice together: Be glad for your friends when good things happen for them, even if
your own life is not going well. Wish others the best life has to offer.
• Be aware: Think about how your actions and reactions affect the people around you.
• Honor yourself: Make sure that your actions are consistent with your own beliefs
and values.

Section 3:

Connecting with others

Develop patience
Patience is accepting the things you cannot change. It means being peaceful, content, satisfied, and willing to
enjoy the moment. When you are patient, you can wait without feeling anxious or frustrated. You will be more
caring, understanding, and accepting of others. Patience is an important part of healthy relationships. Patience
does take practice, especially in a fast-paced world.

Here are some tips to help you be more patient:
• Think of a difficulty or a long wait as a chance to practice your patience.
• Accept that other people’s mistakes will sometimes affect you, just as your
mistakes may affect other people. Be willing to wait for others, just as you
would want them to wait for you.
• Accept and forgive yourself when you become impatient. Make up your mind to
work on it for next time.

Section 3:

Connecting with others

Be safe in relationships
Relationships that are healthy and safe are built on mutual honesty and respect. That means each person
listens to the other’s thoughts and opinions without making a judgment or finding fault. In this kind of
relationship, it is OK to disagree and argue sometimes. However, both people ought to be able to talk about the
issues and find a compromise, even if you agree to disagree.
Think about one of your relationships. Then, read these questions. Check yes or no based on your situation. The
more times you check yes, the healthier your relationship.
____Yes ____No

Do you feel good about yourself when you are around that person? (The person should not
make you feel worried, sad, mad, or scared.)

____Yes ____No

Is your relationship balanced? Is there an equal amount of give and take? (You should not find
yourself giving more attention to the other person than he or she gives to you.)

____Yes ____No

Do you feel safe around the other person? (The person should not make you feel scared,
unsafe, or pressured.)

____Yes ____No

Do you feel that you can trust the other person? (You should be able to depend on the other
person.)

____Yes ____No

Does the other person support you when you make a mistake? (The other person should not
find fault with you all the time, or call you names.)

If you think you might be in relationship that is not healthy for you, let someone know. With help, you can get out
of it or make it better. If you think you may be in a relationship at home that is not safe, call the National
Domestic Violence Hotline at 1-800-799-SAFE (7233) or 1-800-787-3224 (TTY).

Section 3:

Connecting with others

Give help to others in need
Staying connected also means offering help to others. If your friend is in need, offer to find help for her. Listen
with sincere interest, and try not to judge. You can find information on how to help friends in need from many
places:

Your doctor or health care provider

A faith-based advisor

Your local government

The local library

The phone book – look for the YWCA or county services

Audrey’s story: “I’m really busy helping my kids and my grandkids, and over the years I
realized I didn’t have as many friends of my own as I used to. I missed having other women to
talk with. So I started taking a class at our local senior’s center. At first, it was really hard to
make new friends. I’m 62 and have lived on my own a long time, so I’m pretty set in my
ways. But then I realized I needed to spend time listening to the women I met, asking them
questions, and being open with them so they could get to know me. Now I have several new
friends, and we love to get together after class and chat over a cup of coffee.”

Section 3:

Connecting with others

Activities to help you connect with others
Here are some short exercises you can do to help you connect with others. You can do these activities by
yourself, or with friends and family members.
List some parts of your racial, ethnic, or cultural background that shape you in positive ways:

____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
How patient are you? Rate your patience level on a scale of 1 to 10. 1 means you have no patience at all and 10
means you have lots of patience: ______
How do you feel when you are impatient? What would help you be more patient?

Conclusion
Thank you for taking the time to read this guide! We hope it has encouraged you to spend some time thinking
about emotional wellness. Emotional wellness helps you feel good about yourself, your relationships, and your
purpose in life. It has been linked to better physical health and to overall life satisfaction.
The tips in this guide can help you
in life and connect with others. All
better about yourself. Remember,
just as physical fitness is a goal in

learn to appreciate yourself. They can help you find your balance and purpose
of these actions will help you feel
emotional wellness is a goal in itself,
itself.

You can learn to feel your best! We hope this guide helps you along the
way. When you are done with it, please consider sharing it with a friend.

Resources
The following DHHS resources provide general information about women’s health:
• GirlsHealth.gov promotes emotional and physical health for teenage girls and provides information about
body, fitness, nutrition, bullying, and other issues.
WEB www.girlshealth.gov
• MyPyramid.gov advances and promotes dietary guidance for all Americans, including customized guidance
for women based on age and activity level.
TEL 888-779-7264 WEB www.mypyramid.gov
• National Women’s Health Information Center lists health organizations, campaigns and events, publications, and
more. TEL 800-994-9662 TTY 888-220-5446 WEB www.womenshealth.gov
• U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office of
Women’s Health works to raise awareness of women’s health issues and to promote activities that will
improve the health and safety of women.
TEL 800-CDC-INFO (232-4636) TTY 888-232-6348 WEB www.cdc.gov/women
• U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
WISEWOMAN provides women with the knowledge, skills, and opportunities to prevent heart disease and
other chronic illnesses.
TEL 800-CDC-INFO (232-4636) TTY 888-232-6348 WEB www.cdc.gov/wisewoman
• U.S. Department of Health and Human Services, Health Resources and Services Administration,
Maternal and Child Health Bureau, Office of Women’s Health provides leadership and guidance in
developing policy and in establishing goals and priorities for women’s health issues across the lifespan.
TEL 888-ASK-HRSA (275-4772) TTY 888-877-4TY-HRSA (489-4772) WEB www.hrsa.gov/womenshealth
• U.S. Department of Health and Human Services, Office on Women’s Health works to improve the health
and well-being of women in the United States through its programs by educating health professionals and by
motivating behavior change in consumers.
TEL 800-994-9662 TTY 888-220-5446 WEB www.womenshealth.gov/owh

• U.S. Department of Health and Human Services, National Institutes of Health, National
Institute of Child Health and Human Development conducts and supports research on all
stages of human development, from preconception to adulthood, to better understand the health
of children, adults, families, and communities.
TEL 800-370-2943 TTY 888-320-6942 WEB www.nichd.nih.gov

This booklet is about promoting emotional wellness, but some women might need help overcoming anxiety or
depression. If you or someone you know might be depressed, the following resources can help:
• Anxiety Disorders Association of America provides information about anxiety disorders and
treatment. TEL 240-485-1001 WEB www.adaa.org
• Freedom From Fear provides information about anxiety and depression and resources to obtain help.
TEL 718-351-1717 ext. 24 WEB www.freedomfromfear.org
• National Mental Health Association provides information about mental health, including
programs, news, advocacy, and mental health information.
TEL 800-969-NMHA (6642) WEB www.nmha.org
• National Suicide Prevention Lifeline has trained crisis counselors to assist callers with emotional
distress.
TEL 800-273-TALK (8255)
• U.S. Department of Health and Human Services, National Institutes of Health, National
Institute of Mental Health provides information about mental health and mental illness, news
releases, clinical trials, and more.
TEL 866-615-6464 WEB www.nimh.nih.gov
• U.S. Department of Health and Human Services, Substance Abuse and Mental Health
Services Administration provides information on:

— substance abuse problems - National Clearinghouse for Alcohol and Drug Information
TEL/TTY 800-729-6686 En Español 877-767-8432 WEB www.ncadi.samhsa.gov
— mental health problems - National Mental Health Information Center
TEL 800-789-2647 TTY 800-433-5959 WEB www.mentalhealth.samhsa.gov

Bright Futures forWomen’s Health and Wellness
2007

Appendix B:
A Young Woman’s Guide to
Emotional Wellness

B-1

Bright
Futures

A young woman’s guide to emotional wellness

Bright Futures for Women’s Health and Wellness

Welcome!
Thank you for taking the time to read “A Young Woman’s Guide to Emotional Wellness.” This booklet is about helping young
women like you to feel your best.
The tips in this booklet are drawn from the latest research into what helps young women to feel and be their best. The
research suggests that young women can increase their self-esteem and learn skills like flexibility, being strong, and
optimism. Additionally, spiritual practices and support from family and friends can make young women feel better. We
encourage you to adopt the tips in this guide and to share what you learn with your friends!
This booklet is part of a series of materials called "Bright Futures for Women’s Health and Wellness." This series also
includes guides for adult women, community organizations, and healthcare providers. These materials were developed by
the U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Women’s
Health, with the guidance of a 10-member panel of predominantly female mental health experts from around the country
and feedback from young women like you. Bright Futures materials help women achieve better physical, mental, social, and
spiritual health by encouraging healthy practices.
It’s important to note that, while this guide does mention depression and anxiety, it is not intended to help you diagnose or
treat these or other illnesses. If you believe you are suffering from depression, anxiety, or a more serious mental illness,
please see a health care professional who can help you.
We hope you find this guide helpful. When you are finished with it, please share it with your friends!

Sincerely,

Elizabeth M. Duke
Administrator
Health Resources and Services Administration
U.S. Department of Health and Human Services

Table of Contents
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
APPRECIATING YOURSELF . . . . . . . . . . . . . . . . . . . . . . . . . .
Build your self-respect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Build your self-confidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Build your self-esteem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Set your own goals and self-expectations . . . . . . . . . . . . . . . . . . .
Take care of your body. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Think positively . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Make time for activities you enjoy and that have meaning for you . . .
Learn skills that help you cope with difficult emotions and situations .
Quiz and Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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3
4
5
6
7
8
9
10
11
12

FINDING BALANCE AND PURPOSE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Learn about yourself, your family, and your community . . . . . . . . . .
Develop a purpose statement that is based on your personal values.
Set goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Be able to change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Learn skills that can help you deal positively with stress . . . . . . . . .
Increase your confidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Nurture your spirit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Quiz and Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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16
17
18
19
20
21
22
23

CONNECTING WITH OTHERS . . . . . . . . . . . . . . . . . . . . . .
Find a connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Identify with your racial, ethnic, or cultural background . . . . . . . .
Learn about healthy relationships. . . . . . . . . . . . . . . . . . . . . . . .
Learn about empathy and its importance in relationships . . . . . . .
Learn how to be more mindful of other people and their situations.
Develop patience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Be safe in relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Give help to others in need . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Quiz and Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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27
28
29
30
31
32
33
34
35
36

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CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
RESOURCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Introduction
Part of being a young woman

is spending a lot of time thinking about and talking about your emotions.
You probably know when you are happy, sad, proud, angry, excited, and so on. It’s easier for all of us
to think about our emotions when we have them. To be emotionally well, you may also need to think
about how you feel in a broader way. You need to be sure you are aware of all of your feelings – good
or bad – not only when you have them, but at other times, too.
Being emotionally well means feeling good about yourself, your relationships, and your purpose in life.
It does not mean that you will never be sad, angry, or confused. Everyone feels this way from time to
time. When you are emotionally well, you may have fewer lows and may be able to bounce back from
sad times faster. You may also feel more happiness during the good times. All young women can
learn to feel better. Once you learn, you can help your friends learn, too!
This guide has three sections. Each one is important for emotional wellness. These are:

Appreciating Yourself

Finding Balance and Purpose

Connecting with Others

Each section has ideas to help you feel better. It includes quizzes and activities for you to do by
yourself or with your friends. The guide also has stories from young women like you.
All young women are unique, but we hope that every young woman will be able to use some of this
information. As you are looking through it, keep track of the tips that might help you or a friend!

Section 1:

Appreciating yourself

Appreciating yourself
Young women are busy!

Think about it: You might be a friend, a student, a daughter, a sister, a teammate,
an artist, a musician, a writer, an athlete, and many other things!
That’s why it’s important to take some time every day to appreciate yourself. It’s fun, it’s easy, and it will help
you do better in all your different roles.
Appreciating yourself includes things such as focusing on what you do well, getting enough sleep, and eating
right. This section of the guide talks about all the ways you can learn to appreciate yourself:
Build your self-respect
Build your self-confidence
Build your self-esteem
Set your own goals and self-expectations
Take care of your body
Think positively
Make time for activities you enjoy and that have meaning for you
Learn skills that help you cope with difficult emotions and situations

Section 1:

Appreciating yourself

Becky’s story: “When I hang out with my friends, one of the things we like to do is

talk about what we like about one another, even silly stuff like who is great at fixing
hair or who has good taste in music. It makes me feel really good, and we usually
end up laughing together!”

Build your self-respect
Respect is important. All young women want to be respected. But have you ever thought about whether you are
respecting yourself? This means taking care of yourself in four different ways:
Physically: Being active, eating healthy foods, getting enough sleep, and practicing good hygiene.
Mentally: Challenging your mind. This includes learning about yourself and your family history.
Spiritually: Taking time to explore your beliefs about the meaning and purpose of life. Taking time to
think about how you want to guide your life by these beliefs.
Emotionally: Thinking good thoughts about yourself and others.

This guide can help you learn how to respect the most important person in your life – you!

Section 1:

Appreciating yourself

Build your self-confidence
Young women who are confident are able to try new things. They know they can deal with problems. You can
become more confident by setting goals that make sense, thinking positively, and being prepared.

Here are some more tips to increase your self-confidence:
• Stop comparing: Your abilities and talents are unique – special. Decide what success
means for you and don’t worry about what success means for anyone else.
• Remember your good deeds: Remember that time you shared your lunch with a friend
who forgot hers? Or that time you made your best friend a cake on her birthday? You do
lots of great things for other people every day. Appreciate yourself.
• Forgive yourself and learn from your mistakes: Everyone makes mistakes once in a
while. Learn from them and move on. You’re not the only young woman who ever left her
homework on the kitchen table! Just don’t be the one who does that every week.

Section 1:

Appreciating yourself

Build your self-esteem
A young woman with a healthy self-esteem knows what makes her unique and values those things. Self-esteem
helps you feel good about yourself, no matter what other people think of you.

Here are some tips to help you boost your self-esteem:
• Accept your strengths and your weaknesses: No one is perfect, not even the most
popular person you know. Your strengths and weaknesses are what make you special.
• Congratulate yourself and be nice to yourself and others: Honor your achievements,
big and small. Be your own biggest fan. Let others know what you like about them.
• Value yourself: Friends and family are great, but don’t depend on others to make you
feel good about yourself. Value yourself no matter what other people say about you.
• Surround yourself with positive people: Choose friends who value you. Try to ignore
people who make negative comments.
• Praise yourself: Remember one good thing about yourself every day.
• Do good things: Do at least one thing that you feel good about every day.

Section 1:

Appreciating yourself

Set your own goals and self-expectations
Many young women let others tell them what they should be doing and how to do it. To be emotionally well, you
need to judge yourself by your own standards and no one else’s.

These tips can help you set standards for yourself:
• Define beauty for yourself: Images of thin, cute young women are everywhere. Most young
women do not look that way. True beauty comes from inside and shines outward. Focus on
the things about yourself that you think are beautiful.
• Define your own values: Many young women try to live by the values held by their friends or
popular teens or young women they see on TV. The only values you need to live up to are your
own. Think about what they are and stick to them.
• Focus on your strengths: We all have strengths and weaknesses, but many of us focus more
on our weaknesses. Try this instead. Every time you think about one of your weaknesses, think
about one of your strengths, too.

Section 1:

Appreciating yourself

Take care of your body
Most young women know that eating well and being active can make you fit. Did you know that taking good care of
yourself can help your emotional health as well? Physical activity, healthy eating, and getting enough sleep can
improve your mood! Pretty great, huh?
To learn more about physical activity and healthy eating, read “My Bright Future: Physical Activity and Healthy
Eating Tools for Young Women.” You can download a free copy at www.hrsa.gov/womenshealth.

You don’t have to make a lot of big changes. Start with small steps:
• Healthy eating habits: Decide on just one thing you would like to do to eat healthier. Keep doing
it until it becomes a habit. Then try to form another good eating habit. (If you aren’t sure what
healthy eating means, here is one definition: Healthy eating means eating a variety of nutrientdense foods and beverages within and among the basic food groups, while choosing foods that
limit your intake of saturated and trans fats, cholesterol, and added sugars or salt.)
• Physical activity: Add a few minutes of walking or some other form of exercise to your day. Keep
adding minutes until you’ve reached your goal. (One goal is to aim for at least 60 minutes of
walking or other moderate physical activity on most days of the week.)
• Set an earlier bedtime: Go to bed 10 minutes earlier than usual. Keep doing it until you’ve
reached your goal. (Most young women need about eight hours of sleep a night.)
• Develop good sleep habits: Once you’ve found the right bedtime, try to go to bed at about the
same time every night. Try not to eat, drink caffeinated beverages, or exercise right before bed.

Imagine how doing just one of these small steps on a regular basis can add up at the end of a month!

Section 1:

Appreciating yourself

Think positively
Positive thinking actually helps you deal with your problems! No one can think positively all the time, but every
young woman can learn how to feel more optimistic.

Here are some tips:
• Look for the positive: When things go wrong, think of something good about the situation.

Suppose a friend cancels your plans. Look at it as more time to do something for yourself
like reading a book, calling another friend, or watching a movie.
• Focus on the good things: Even when something has upset you in one part of your life, you

can still focus on the things you value in other areas.

Padma’s story: “My mom has this rule that I used to think was really lame, but
now I kind of like it. Every month, we all have to spend a few hours doing
something good for someone else. Sometimes, we all do the same thing and
sometimes everyone picks something different. Like this month, I helped my
neighbor weed her garden. We had a great time, and it does feel kind of nice to
help someone else.”

Section 1:

Appreciating yourself

Make time for activities you enjoy
and that have meaning for you
You’d be surprised at how much happier you are when you are doing something that has meaning for you.

Here are some tips on how to get started:
• Find activities that are important to you: Spend your time on things you care about, not
things someone else thinks you should do. You will be more committed to them and enjoy
them more!
• Start a club: If there’s no group at your school working on the issues you care about, talk
to a teacher to find out how to start one. It can give you experience and skills, which will
help you find a job when you finish high school or apply to a college or a trade school.
• Do things with your friends: Make meaningful activities part of what you do when you
hang out with your friends.
• Schedule it in: Even busy young women can find time to take part in activities they enjoy
and that have meaning to them. Practice scheduling your time now. It will also help to
prepare you for later on when you have a job or if you continue your education.

Section 1:

Appreciating yourself

Learn skills that help you cope with
difficult emotions and situations
Coping is the way we deal with problems and stress. It’s part of life to be stressed sometimes, but knowing how
to cope will help you get through the tough times.

Here are some suggestions to help you cope:
• Express yourself: Write your feelings in a journal, sing along with your favorite song, act
out a scene from a movie, or find some other way to express your feelings.
• Take care of yourself: Get plenty of rest. Eat healthy foods and be physically active. Don’t
do anything out of the ordinary. Instead, try to find comfort in your usual routines.
• Stay connected to others and tell them how you are doing: When you’re stressed out,
you need other people. Find someone you trust to talk to, call, e-mail, text message, or IM.
• Ask for help: If you feel overwhelmed, ask friends, parents, a school counselor, a teacher,
a pastor, rabbi or other faith-based advisor, or your health care provider for advice or help.
Being strong means knowing when to seek help. Everyone needs help from time to time.

Section 1:

Appreciating yourself

Quiz: Are you an optimist?
Optimists see the sunny side of things. Are you an optimist? Take this quiz to find out.
1. You open your locker at school and notice that someone left you a note. Your first thought is:
____
Wow, this is great! (2)
____
Oh, no, this must be bad. (0)
2. When they talk about me, my friends and family say:
____
She expects things to go her way. (2)
____
She always assumes the worst. (0)
3. When you wake up in the morning, you are:
____
Ready to rise and shine! (2)
____
Dreading starting a new day. (0)

Section 1:

Appreciating yourself

4. You break your foot and need to be on crutches. You think:
____
I’ll get all my friends to sign my cast! (2)
____
Ugh, this could only happen to me! (0)
5. When your best friend is sad, you can be counted on to:
____
Cheer her up by looking on the bright side. (2)
____
Join in, because misery loves company. (0)
Scoring:
0-5 The clouds are out!
You are more of a negative thinker than an optimist. Sometimes, just thinking that things will go well seems to
make them go well! If you have confidence in yourself, it can have an amazing effect on the way you think. Try to
think more positively. And look up – the sun is about to come out!
6-10 Break out the sunglasses!
You think like an optimist! Keep it up. Having a positive attitude can actually make things go well. People
probably love being around you because of your positive attitude and confidence. You are a ray of sunshine!

Section 1:

Appreciating yourself

Activities to help you appreciate yourself
Here are some short exercises you and your friends can try to help you learn to appreciate yourself!
Name two things you are good at:

_______________________________________________

Name two things about you that you think are beautiful (inside and out):

_______________________________________________

Think about what makes you feel good and why.

Now think about what makes you feel stressed and why.

Section 2:

Finding Balance and Purpose

Finding balance and purpose
Every young woman’s life has a purpose. To understand what yours is and learn how to live it,

you’ve got to know how to balance all that life brings your way. Follow these steps, and you’re on your
way to being a young woman on a mission:

Learn about yourself, your family, and your community

Develop a purpose statement that is based on your personal values

Set goals

Be able to change

Learn skills that can help you deal positively with stress

Increase your confidence

Nurture your spirit

Ready? Set? Go!

Section 2:

Finding Balance and Purpose

Learn about yourself, your family, and your
community
You might not ever think about it, but we all need to take the time to learn about ourselves, our families, and
our communities. If you don’t learn about yourself and where you come from, how can you be sure you are
working toward the right goals? One way to make sure you are on the right track is through writing. Don’t worry
about complete sentences or spelling. Just let your thoughts flow onto the paper. If you have a creative style,
add drawings and use colorful pens!
Here are some ideas to get you started:
I am happiest when…
I am proud of myself because…
I was born to…
In my dreams, I…
I believe in my abilities to do great things because…
I’m proud of my family or community because…

Section 2:

Finding Balance and Purpose

Develop a purpose statement that is based on your
personal values
Do you ask yourself, “Why am I here? Who am I? What is my purpose in life?” These are good questions to
ask. The meaning and purpose of life is unique for every young woman.
A purpose statement describes how you want to live your life. You can update your purpose statement as your
goals change.

Here are two examples:
• I will be the best me I can be. I will work hard in school, enjoy my friends, take care of
myself, and enjoy the little things in life every day.
• I will love life by taking pleasure in the small things, loving my family and friends, and
accepting my responsibilities. I will welcome each day with a smile.

Latisha’s story: “My English teacher had us do a class exercise where everyone wrote

down something they wanted to do in life, and some small steps for how to get there. I’ve
always wanted to be a pilot, but I never really thought I could do it. I wrote down some
small steps like talking to a pilot about it the next time I fly or going to the library to learn
about what’s involved. It seems more possible now.”

Section 2:

Finding Balance and Purpose

Set goals
Every young woman has things she wants to do. She may have goals for the future such as going to college
someday or getting ready for the job she would like to have. She may have goals for right now like doing well on
a test. Setting and reaching your goals helps you feel good about yourself. Try to focus on a few goals at a time.
Remember, once you have completed one goal, you can start on another!
You can use the following steps to set any goal:

Write down your goal: Write your goals in a positive way. For instance, write, “Learn to play the piano

better,” instead of, “Don’t make mistakes while playing the piano.” Keep your goal somewhere you can see it
often to help you focus.

Set a deadline for achieving the goal: Write down the dates, times, and amounts so that you can see how

well you are doing.

Know your obstacles: List things that might stop you from reaching your goal.

Identify who can help: Write down who can help you reach your goal.

Identify what you need to know: List the skills you need to reach your goal.

Create an action plan: Make a plan for learning the skills you need to reach your goal.

Know the reason: Write down the benefits of achieving your goal.

Make sure your goals are realistic! If your goal is to get more sleep, don’t try to go to bed an hour earlier right
away. Instead set smaller goals of going to bed 5 or 10 minutes earlier each night. In other words, take small
steps, and keep on taking them every day. Celebrating your small goals along the way will keep you on the road
to achieving your goals!

Section 2:

Finding Balance and Purpose

Be able to change
Change is a fact of life (and not just for your hair). Some young women know how to bounce back when things are
difficult or how to learn from these experiences. You can learn to be that way if you focus on three things:

Outside supports: These include friends and other resources that make
you feel safe and free to grow. Turn to the people you trust in difficult
times.

Inner strengths: Know your best personality traits – like optimism,

kindness, or confidence – and draw on those traits for strength when
you need it.

Learned skills: Know what skills you need to work on, and develop them
when things are going well for you. For example, if you don’t think you
are a good communicator, ask a friend to help you better express your
feelings.

Section 2:

Finding Balance and Purpose

Learn skills that can help you deal positively with
stress
You probably deal with a lot of stress. This could be stress from impossible homework to fights with your
brother. Knowing how to deal with stress is an important part of being emotionally well.

Here are some tips for dealing with stress:
• Know how you react: Think about how you act in times of stress. Do you like the way you

respond? How could you improve?
• Seek guidance: Ask others – such as friends, a pastor, rabbi, or other faith-based advisor,
counselors, teachers, or your parents or guardians – how they respond to stress. Try
what seems to work well for them.
• Make a plan: Think about how you want to act when you are stressed. Write down the
names of people you would ask for help.
• Be ready to change: Think about how open you are to change. Think about how you can
accept change in times of stress.

Section 2:

Finding Balance and Purpose

Increase your confidence
Have you noticed how some young women have a ton of confidence, while others struggle to believe in
themselves? Confidence isn’t about ability. It’s about attitude! All young women can learn to be more confident.

Here are three ways you can build your confidence:
• Doing what you do best: The best way to begin feeling more confident is to focus on the
things you already do well. If you don’t know what things you do best, ask your friends and
family. Spend more time on what you do best, and congratulate yourself for your
successes.
• Seeing others do it: Seeing someone like you succeed will help you believe that you can
do it, too. If there is something you have always wanted to do, find a friend or family
member who is doing it. Ask if you can watch. Then, see if she will help you get started!
• Use your emotions: If you have a hard time starting something, use your emotions to help
you take action. It’s OK to be excited, nervous, or afraid about something new. Accept
those feelings and use the emotions to get you moving.

Section 2:

Finding Balance and Purpose

Nurture your spirit
Just like your body tells you when you are physically tired, you can learn to know when you are emotionally tired. When
that happens, take a break to renew and recharge your soul. Take time to tune out the world. Connect with yourself and
refresh your spirit.
Here are some ideas on how to slow down, turn your focus inward, and recharge:
Sip a cup of hot chocolate or drink a glass of cold lemonade.
Take a long shower or bath. Pamper yourself.
Write down your thoughts, or express yourself through art or music.
Meditate or pray.
Put on your headphones and listen to some music. Read a book or magazine.
Sit quietly and feel your breath.
Take a walk and look at nature. Focus on enjoying the simple beauty of the world around you.
Use a calendar to organize your time, and write in some time for yourself.

Shelly’s story: “If I have a really long day at school, or a fight with one of my friends,
or whatever, I like to take some time just for me. I go down to the river and focus on
the running water, or watch the birds fly and just relax. I might meditate, or sing,
anything until I feel more peaceful again.”

Section 2:

Finding Balance and Purpose

Quiz: Are you good to yourself – mind and body?
You are probably good to your friends, but are you good to yourself? Take this quiz to find out.
1. When I think about taking care of myself, I say:

____

No way, it’s not my thing. (0)

____

Sure, sometimes. (1)

____

You know it! Taking care of myself comes first. (2)

2. In your free time, you:

____

Free time? What’s free time? (0)

____

Do volunteer work. (1)

____

Do a variety of things. (2)

3. Your exercise schedule is something like:

____

Once a year. (0)

____

A couple of times a month. (1)

____

A couple of times a week. (2)

4. It’s important to me to eat well:

____

Never, I just eat whatever when I can. (0)

____

Most of the time, but sometimes I forget. (1)

____

Always, I need good food to feel my best. (2)

Section 2:

Finding Balance and Purpose

5. Your personal saying is:

____

A busy life is a happy life. (0)

____

Work hard, play hard. (1)

____

I am a beautiful part of a beautiful world. (2)

Scoring:
0-3 Slow down!

You work hard – way hard! This is not always a bad thing, but trying to balance work and play is important for
both your mind and body. Your hard work is wonderful, but don’t overdo things. Taking time for yourself – such
as doing a hobby, eating well, or exercising – will help.
4-6 Take time to enjoy life.

A hard-working person like you knows what she wants and goes after it. You will go far in life, but continue to
stop and smell the roses along the way.
7-10 You’re good to yourself!

Ahhh, you know how to live a balanced life. You understand your body’s need for work and play, social and alone
time, hard work and creativity. You know what your mind and body need and listen to them. Good for you!

Section 2:

Finding Balance and Purpose

Activities to help you find balance and purpose
Here are some short exercises you and your friends can do to help you find balance and purpose in life.
What is one thing you would like to do in your life?
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________

How could you make more time for yourself?

____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________

Section 2:

Finding Balance and Purpose

Write down and plan for one of your personal goals:

What is your goal?

When do you want to achieve your goal?

What might stop you from achieving your goal?

Who can help?

List the skills and knowledge you need to reach your goal.

Make an action plan.

List the benefits of the goal.

Section 3:

Connecting with others

Connecting with others
Connections are important to young women!

You can connect with people in a lot of different ways. You can
connect with others in your school, your neighborhood, your ethnic group, your online buddy list, a club you belong
to, and so on.
Being connected to others makes you feel good. It also helps your emotional health.
This section of the guide has tips to help you connect with others:

Find a connection

Identify with your racial, ethnic, or cultural background

Learn about healthy relationships

Learn about empathy and its importance in relationships

Learn how to be more mindful of other people and their situations

Develop patience

Be safe in relationships

Give help to others in need

Section 3:

Connecting with others

Find a connection
Young women have a deep need to feel connected. That’s why many spend a lot of time connecting with friends
through the phone, text messaging, e-mail, or instant messaging.

Here are some other things you can do to be more connected:
• Join a sports team, a club, the band, the newspaper, or some other group at your school. Or,
run for student council!
• Volunteer in your neighborhood or community. Check with local community groups to see if they
need volunteers. Or, ask a parent, teacher, or friend for advice on where you can get involved.
• Pick up your school newspaper or a local paper. Go to one of the listed events with a friend.
• Sign up for an exercise or arts class.
• Spend more time with your family.

Aisha’s story: “My family moved last year when my parents got divorced, and I had to start

going to a new high school. I hated being the new girl and not having any friends. I’m really
good at tennis, and I like to write, so I joined the yearbook staff and the tennis team. Having
these things in common with the other kids helped me to make some friends.”

Section 3:

Connecting with others

Identify with your racial, ethnic,
or cultural background
All families are unique! Some young women may feel a part of and draw strength from their racial, ethnic, or cultural
communities. Those ties tell the stories of where we came from. Taking pride in your heritage is one way to connect
with others.

Here are some ways to learn more about your background:
• Interview a family member.
• Go to a local cultural event.
• Research issues related to your background on the Internet or at the library. You could also try to
find out more about your last name or family history.
• Help set up an ethnic potluck at your school.
• Read a book or visit a Web site about your history.

Section 3:

Connecting with others

Learn about healthy relationships
Friends aren’t just fun, they make us feel better, too! Just having friends and family to talk to makes you feel
good. Here are a few of the things needed in healthy relationships:

Respect: In a good relationship, both people respect each other.

Mutuality: Healthy relationships go both ways. Both people give to each other and receive from each other.

Communication: It is important to talk with, and listen to, other people. Let other people get to know you.

Ask questions so you can get the chance to know others.

Honesty: Honesty is a sign of respect in healthy relationships.

Trust: Over time, good friends earn your trust.

Flexibility: People and situations change. In a good relationship, people are flexible.

Dependability: Follow through on the things you say you will do. Be a dependable friend.

Section 3:

Connecting with others

Learn about empathy and its
importance in relationships
Part of connecting with others is learning how to understand what the other person is feeling. Empathy means
being able to put yourself in someone else’s shoes. Look for friends who are empathetic. Learn how to “walk in
someone else’s shoes.”
It’s not always easy to do this, because sometimes we all do things we wish we had not done. For example, did
you ever forget your sneakers on gym day? Just remember, this kind of thing happens to everyone, and
everyone wants to be treated kindly.
Here are two steps you can take to show empathy. First, give a brief reply that captures the situation; then, add
an emotion.
Suppose a friend tells you about a fight with her brother. You can say, “When he was yelling at you, you must
have felt mad.” This shows that you are really listening and trying to understand how your friend is feeling.

Section 3:

Connecting with others

Learn how to be more mindful of other
people and their situations
Sometimes, it’s hard to focus on other people when you have problems in your own life, but good friends make
an effort to focus on others. Being mindful means having your mind present in a situation. It means you think
and care about other people’s feelings while also being aware of your own feelings.

Here are some ways to be mindful:
• Be present: Be aware of your own thoughts and feelings.
• Show respect: Listen to your friends. Really think about their thoughts and feelings.
• Be considerate: Think about the needs of others. Help them when you can, even before they ask

for help.
• Rejoice together: Be glad for your friends when good things happen for them, even if your own life

is not going well.
• Be aware: Think about how what you do or say affects the people around you.
• Honor yourself: Make sure that you act according to your own beliefs and values.

Section 3:

Connecting with others

Develop patience
Patience is accepting the things you cannot change and being peaceful, content, and willing to enjoy the
moment. Patience takes practice, especially in a fast-paced world, but patience is essential if you want to
connect with others.

Here are some tips to increase your patience:
• Think of a difficulty or a long wait as a chance to practice your patience.
• Accept that, just as your mistakes sometimes slow other people down, other people’s
mistakes will sometimes slow you down. Be willing to wait for others, just as you would want
them to wait for you.
• Accept and forgive yourself when you are not patient. Remember to work on it for next time.

Sarah’s story: “It drives me crazy when my mom runs all over town doing errands and

I have to come along, or when my little sister takes all morning in the bathroom. I
guess I’m not very patient. Since I know I’m going to have to wait anyhow, I try to use
the time to do something else. Like, with my mom, I try to learn where all the streets
are as we drive, since I will get my driver’s license soon. And while I’m waiting to get
into the bathroom, I take the extra time to talk to my stepfather about my school and
his work and stuff.”

Section 3:

Connecting with others

Be safe in relationships
Part of being a young woman is learning how to be in relationships with many kinds of people. This includes
friends, family members, and teachers. It also includes someone you are or want to be dating. It is hard to
learn how to form safe and healthy relationships. Always let an adult know where you are going and who you’ll
be with. Tell someone right away if you are in any relationship where you do not feel comfortable or safe.
Safe and healthy relationships are built on honesty and respect. That means each person listens to the other’s
thoughts and opinions without making a judgment or finding fault. In healthy relationships, it is OK to disagree
and argue sometimes. However, both people ought to be able to talk about the issues and find a compromise. It
is even OK to agree to disagree.
Here is a way to check and see how healthy one of your relationships is. Read the questions below. Then check
yes or no based on your situation. The more times you check yes, the healthier your relationship.
____Yes ____No

Do you feel good about yourself when you are around that person? (The person should
not make you feel worried, sad, mad, or scared.)

____Yes ____No

Is your relationship balanced? Is there an equal amount of give and take? (You should not
find yourself giving more attention to the other person than he or she gives to you.)

____Yes ____No

Do you feel safe around the other person? (The person should not make you feel scared,
unsafe, or pressured.)

____Yes ____No

Do you feel that you can trust the other person? (You should be able to depend on the
other person.)

____Yes ____No

Does the other person support you when you make a mistake? (The other person should
not find fault with you all the time or call you names.)

If you think you might be in an unhealthy relationship (or if you have a friend who is), let an adult know. Talk to your school
counselor, a trusted teacher, a coach, a neighbor, or a parent. With help, you can get out of it or make it better.

Section 3:

Connecting with others

Give help to others in need
Helping others isn’t just for Girl Scouts! Being a good friend means offering help whenever you can. Listen with
sincere interest, and try not to judge. Offer to try to find help for friends in need. You can find information on
how to help from many places:

Your school counselor or a trusted teacher or coach

Your doctor or health care provider

A leader at your church, synagogue, or mosque

The local library

The phone book – look for the YWCA or county services

Section 3:

Connecting with others

Quiz: How patient are you?
You’ve heard it said that patience is a virtue. Are you patient? Take this quiz to find out.
1. You are shopping and the cashier is very slow. You:

____

Look around while standing in line. (2)

____

Get flustered and leave the store. (0)

2. You are out of town and forget your toothbrush. You:

____

Smile and think it will be an adventure to find a store in a new place. (2)

____

Get angry at yourself for forgetting. (0)

3. When your friend disagrees with others, you:

____

Listen to what she has to say and think about it from her perspective. (2)

____

Immediately tell her she is wrong. (0)

Section 3:

Connecting with others

4. You are with a younger girl in gym class and she is not catching on very well. You:

____

Tell her that you think she is doing a good job to boost her confidence. (2)

____

Tell her you are too busy to help her. (0)

5. You are stuck on the bus because of a nearby accident. You:

____

Use the time to start on your homework. (2)

____

Stress out about how late you will be. (0)

Scoring:
0-5 Patience is a virtue.

No one is perfect. Sometimes, other people will slow you down or things will take longer than you planned. Accept
that other people may not be as quick as you are, and try not to sweat the small stuff. You may even learn
something new while you wait!
6-10 You’re in control of your mood.

You seem to have common sense in any situation and are in check with your mood. People lean on you in times
of crisis. Make sure you pay attention to how you’re feeling. Continue to be thoughtful and patient in your
relationships.

Section 3:

Connecting with others

Activities to help you connect with others
Here are some short exercises you and your friends can do to help you connect with others.
List some parts of your racial, ethnic, or cultural background that shape you in positive ways:
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
What are some needs in your community? How could you get more involved to help?
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
How do you feel when you are not patient? What would help you learn patience?
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________

Conclusion
Thank you for taking the time to read this guide! We hope it has encouraged you to spend some time thinking
about emotional wellness. Emotional wellness helps you to feel good about
yourself, your relationships, and your purpose in life. It has been linked to better
physical health and to being content with life.
The tips in this guide can help you learn to appreciate yourself. They can help you
find your balance and purpose in life and connect with others. All of these actions
will help you feel better about yourself. Think of emotional wellness as a goal in
itself, just as physical fitness is a goal in itself.
You can learn to feel your best! We hope this guide helps you along the way.
When you are done with it, please consider sharing it with a friend.

Resources
The following resources provide general information about women’s health:

• GirlsHealth.gov promotes emotional and physical health for teenage girls and provides information about
body, fitness, nutrition, bullying, and other issues.
WEB www.girlshealth.gov
• MyPyramid.gov advances and promotes dietary guidance for all Americans, including customized dietary
guidance for young women based on age and activity level.
TEL 888-779-7264 WEB www.mypyramid.gov
• National Women’s Health Information Center lists health organizations, campaigns and events, publications, and
more. TEL 800-994-9662 TTY 888-220-5446 WEB www.womenshealth.gov
• U.S. Department of Health and Human Services, Health Resources and Services Administration,
Maternal and Child Health Bureau, Office of Women’s Health provides leadership and guidance in developing
policy and in establishing goals and priorities for women’s health issues across the lifespan.
TEL 888-ASK-HRSA (275-4772) TTY 888-877-4TY-HRSA (489-4772)
WEB www.hrsa.gov/womenshealth
• U.S. Department of Health and Human Services, Office on Women’s Health works to improve the health
and well-being of women in the United States through its programs by educating health professionals and by
motivating behavior change in consumers.
TEL 800-994-9662 TTY 888-220-5446 WEB www.womenshealth.gov/owh

This guide is about emotional wellness, but some young women might need help with anxiety or depression. If you think
you or someone you know might be depressed, you can talk to your school counselor, school nurse, or a trusted
teacher, coach, or parent for help. These groups also can help:

• Anxiety Disorders Association of America provides information about anxiety disorders and treatment.
TEL 240-485-1001 WEB www.adaa.org
• Freedom From Fear provides information about anxiety and depression and resources to obtain help.
TEL 718-351-1717 ext. 24 WEB www.freedomfromfear.org
• National Mental Health Association provides information about mental health, including programs, news,
advocacy, and mental health information.
TEL 800-969-NMHA (6642) WEB www.nmha.org
• National Suicide Prevention Lifeline has trained crisis counselors to assist callers with emotional distress.
TEL 800-273-TALK (8255)
• U.S. Department of Health and Human Services, National Institutes of Health, National Institute of
Mental Health provides information about mental health and mental illness, news releases, clinical trials,
and more.
TEL 866-615-6464 WEB www.nimh.nih.gov
• U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services
Administration provides information on:

Bright Futures forWomen’s Health and Wellness
2007

Appendix C:
Data Collection Instruments and Data to be Collected

C-1

Data Collection Instruments and Data to be Collected
Instrument

Data Collected

Consumer Survey

Data Points

 Self-administered written survey
 Includes informed consent form (from consumer
and parent or legal guardian for minors)
 22 questions (21 multiple choice and 1 openended question)
 15 minute response time
 Distributor gives survey to consumer at the time
of service (e.g., at end of a medical appointment
or a group prenatal care session)
 Approximately 750 consumers will be asked to
respond (including all four sites)
 Seeking 50-75% response rate (for a total of
approximately 560 completed surveys)
 Completed surveys to be sent in the mail to the
evaluation team by the evaluation site staff or the
respondent to ensure confidentiality

Emotional Wellness Guide Distributor Survey
 Self-administered web-based survey
 Includes informed consent form
 34 questions (mostly multiple choice with some
open-ended questions)
 15 minute response time
 All evaluate site staff involved in distributing the
emotional wellness guides (e.g. health care
providers, counselors, outreach workers) will be
invited to respond (approximately 40
distributors)
 Seeking 90% response rate or higher

Consumer Focus Groups
 Adult and young women from the evaluation
sites will be given the emotional wellness guides,

 Age, race/ethnicity, and education
 Types of services received from
evaluation site
 Frequency of visits to evaluation site
 Consumer’s overall experience receiving
services from evaluation site
 Overall level of concern about mental
health and emotional wellness
 Extent to which they experience
challenges in areas discussed in guides
(self-appreciation, balance and purpose,
connecting with others)
 Consumer’s experience receiving the
guide from providers
 The extent to which the consumers found
the guides easy to read and understand,
useful/actionable, and relevant to their
lives
Data Points
 Age, sex, and race/ethnicity
 Professional qualifications, role in
organization, and years of experience
 Types of services they provide
 Types of consumers they interact with
 Types of emotional issues, concerns, or
problems reported by females
 Frequency with which an interest in
emotional health or emotional issues are
reported by women they serve
 Comfort level in talking about emotional
wellness issues with the women they
serve
 Frequency of guide distribution
 Experience distributing the guides
 Assessment of the usefulness, relevance,
and cultural appropriateness of the
guides for the women they serve
 Expectations with regard to their
continuing to distribute the guides
beyond the evaluation period
Data Points
 Assessment of extent to which they
experience emotional health challenges

C-2

Instrument









given time to review them and invited to
participate in on-site focus groups
6-8 adult women in one focus group at each site
6-8 young women in a separate focus group at
each site
Not all sites will have both young and adult
women.
May hold separate focus groups for different
ethnic groups – particularly for the younger
women’s groups
Obtain informed consent from focus group
participants
Discussion guide will be used to conduct focus
groups

Data Collected





in the areas discussed in guides
Assessment of how easy guides are to
read and understand
Assessment of whether the issues
discussed in the guides seem relevant to
their lives
Assessment of whether guides offer
information that would be useful to
improving their emotional health
Comfort level discussing issues of
emotional health with providers, and
whether this might change as a result of
being offered the BFWHW guides

C-3

Appendix D:
Evaluation Questions and Indicators for The Bright Futures for
Women’s Health and Wellness Emotional Wellness Consumer
Guides

D-1

OMB Supporting Statement for the
Bright Futures for Women’s Health and Wellness Initiative
Evaluation Questions and Indicators for The Bright Futures for Women’s Health and Wellness Emotional Wellness Consumer Guides

Intervention
Distribution by
participating
program sites
of:
1) The Young
Woman’s
Guide to
Emotional
Wellness,
and
2) The
Women’s
Guide to
Emotional
Wellness

Bright Futures
Evaluation Questions
Dissemination Process

INDICATORS
Process Indicators

Impact Indicators

# of guides distributed at each site by  Impact of the guide distribution on the
age group and race/ethnicity
service encounter and the interaction
1. What are the major factors, barriers and
between the consumer and guide
 % of women receiving services who
facilitators that impact the distribution of
distributor (e.g. length of visit, type
remember seeing the guides at each
these guides to young and adult women?
and quality of the discussion,
site, by age and race/ethnicity
Some potential factors include:
additional referrals made)
 % of practitioners/professionals who
 The community or provider setting
 % of distributors at each site who plan
participated in the distribution
 The goal or mission of the site
to continue using the guides as part of
demonstration who actually
distributing the guides
their routine practice
distributed the guides
 The extent to which emotional wellness  Barriers and facilitators to guide
is a primary focus of the distribution
distribution
site
 The community or provider setting
 The process used by participating sites
 The goal or mission of the site
to distribute the guides
distributing the guides
 The types of situations or settings (e.g.

The extent to which emotional
in the context of an medical


D-1

OMB Supporting Statement for the
Bright Futures for Women’s Health and Wellness Initiative

Intervention

Bright Futures
Evaluation Questions
appointment, support group, or home
visit) used to distribute the guides
The extent to which the emotional
wellness guides complement other
health and educational materials used
by the distribution sites

INDICATORS
Process Indicators

2. Have the guides been accepted by the
distributing organization and their
distribution made a part of routine practice?

wellness is integrated into the set
of services offered by the
distribution site
 The process used by participating
sites to distribute the guides
 The types of situations or settings
(e.g. in the context of an medical
appointment, support group, or
home visit) used to distribute the
guides
 The extent to which the guides
complement other health and
educational materials used by the
distribution sites
 Other factors impacting the use of the
guides

Ease of Use





4. Do distributors find the guides easy to
explain and talk about?

% of women who remember receiving
the guides and rate them on a scale as
easy to read and understand
 % of individual distributors who rate
the guides on a scale as easy to explain
and talk about at each site

Acceptability/Relevance



3. Do young and adult women find the guides
easy to read and understand?

5. Do the women who receive the guides find
them useful?
 Do women think that the guides
provide information they can use to
improve their emotional health?

% of women at each site who report
they have concerns about their
emotional health
 % of women at each site who report
they would like more information or
help about how to improve their

Impact Indicators

% of women who remember receiving
the guides and rate them on a scale as
being useful at each site, by age and
race/ethnicity
 % of women who remember receiving
the guides who say the tools provide
information they can use to improve


D-2

OMB Supporting Statement for the
Bright Futures for Women’s Health and Wellness Initiative

Intervention

Bright Futures
Evaluation Questions





Do women think the guides are
relevant to their lives?
Do women think the guides are
culturally appropriate?
Do women who express an interest in
emotional health or report concerns or
challenges in the areas of emotional
health and wellbeing (e.g. in the areas
of appreciating yourself, finding
balance and purpose, and connecting
with others) find the guides more
useful than the general population of
women being served?

INDICATORS
Process Indicators

Impact Indicators

emotional health and wellbeing
their emotional health
Women and distributor feedback on
 % of women who remember receiving
the cultural appropriateness of the
the guides who rate them being
relevant to their lives
guides – OR -- (if asked on survey) %
of women who rate the tools on a scale  % of distributors at each site who rate
as culturally appropriate
the guides as being useful
 % of individual distributors who rate
 % of distributors at each site who rate
the guides as culturally appropriate
the guides as being relevant to the lives
of the women they serve


6. Do the distributors of the guides find them
useful?
 Do distributors of the guides think they
provide information that will be useful
to women?
 Do distributors think the guides are
relevant to the lives of the women they
serve?
 Do distributors of the guides think they
are culturally appropriate for the
women they serve?
Effectiveness
7. Do the guides improve women’s
understanding of factors contributing to
emotional health and wellbeing?
8. Do the guides help increase women’s

% of women who receive the guides
who report a greater degree of
willingness to talk with health and
social service providers about their
emotional health.
 % of distributors who report having
more conversations about emotional


D-3

OMB Supporting Statement for the
Bright Futures for Women’s Health and Wellness Initiative

Intervention

Bright Futures
Evaluation Questions
comfort level talking to health and social
service providers or other community-based
organization staff about their emotional
health?

INDICATORS
Process Indicators

Impact Indicators
wellness with the women they serve as
a result of the tool distribution (e.g.
questions being asked by women, or
concerns being raised by women)
 % of women who remember receiving
the guides who report that they
improved their understanding of
factors contributing to emotional
health and wellbeing (e.g. selfappreciation, balance and purpose,
connecting with others)

D-4

Appendix E:
Consumer Survey

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number. The OMB control number for this
project is 0915-xxxx. Public reporting burden for this collection of information is estimated to average 15 minutes per
response, including the time for reviewing instructions, searching existing data sources, and completing and
reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600
Fishers Lane, Room 10-33, Rockville, Maryland, 20857.

Bright Futures for Women’s Health and Wellness (BFWHW) Initiative
Consumer Survey
DRAFT
Please answer the following questions by checking the circle or circles next to your answer: Please pick one
answer for each question.
1. How old were you on your last birthday?
 13-17
 18-24
 25-44
 45-64
 65+
2. Are you Hispanic or Latina?
 Yes
 No
3. Which one of the following would you say is
your race?
 White
 Black
 American Indian or Alaska Native
 Asian
 Native Hawaiian or other Pacific Islander
 Two or more races
4. What is the highest level of education you
have completed?
 Eighth grade or less
 Some High School
 High School/GED (General Educational
Development)
 Some College, technical or trade school
 College Degree
 Graduate Degree
5. What is your marital status?
 Single, never married
 Married
 Living with Partner/Cohabitating
 Separated/Divorced
 Widowed
6. About how many times in the last 12 months
have you had an appointment with this clinic
for health care or other services?
0
 1-3
 4-6

 More than 6

7. What types of services were you seeking
here today (check all that apply)?
 Prenatal/maternity care
 Routine check-up
 Treatment for illness
 Emotional health counseling
 Support group
 Other_______________________
8. What is your overall satisfaction with
receiving services from this clinic?
 Very satisfied
 Mostly satisfied
 A little satisfied
 Mostly unsatisfied
 Very unsatisfied
9. How comfortable are you talking to doctors
and other health care providers about your
emotional health and wellbeing?
 Very comfortable
 Mostly comfortable
 A little comfortable
 A little uncomfortable
 Very uncomfortable
10. In the last 12 months, about how many times
have you talked about your emotional health
and well-being with a doctor, counselor or
other health care provider?
0
 1-3
 4-6
 More than 6
11. How happy, satisfied, or pleased have you
been with your personal life over the last
month?

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. The OMB control number for this project is 0915-xxxx.
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time
for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-33, Rockville, Maryland, 20857.

 Extremely happy, could not have been
more satisfied or pleased
 Very happy most of the time
 Generally happy, pleased
 Sometimes fairly satisfied, sometimes
fairly unhappy
 Generally dissatisfied, unhappy
 Very dissatisfied, unhappy most of the
time
12. During the past month, how much of the
time has your daily life been full of things
that were interesting to you?
 All of the time
 Most of the time
 A good bit of the time
 Some of the time
 A little of the time
 None of the time
13. During the past month, how often did you
feel there were people you were close to?
 Always
 Very often
 Fairly often
 Sometimes
 Almost never
 Never
14. Have you been given a copy of the BFWHW
Emotional Wellness Guide (either the Young
Women’s or the Women’s Guide)?
 Yes
 No
 Unsure
If you answered “Yes” to Question #14, please
answer the rest of the questions on this survey..
If you answered “No”or “Unsure” to Question
#14, please only answer question #22.
15. Did you read all or part of the BFWHW
Emotional Wellness Guide?
 All of it
 Part of it
 Just skimmed it
 No

16. How easy is the BFWHW Emotional
Wellness Guide to read and understand?
 Very easy to read and understand
 Mostly easy to read and understand
 A little easy to read and understand
 A little hard to read and understand
 Very hard to read and understand
17. Do you think the BFWHW Emotional
Wellness Guide contains advice that you can
use to feel better about your life?
 Yes, it contains very useful advice
 Yes, it contains mostly useful advice
 No, the advice is not useful
 Unsure
18. Did the personal stories and examples in the
BFWHW Emotional Wellness Guide seem
familiar to you or relate to your own life?
 Yes, very related
 A little related
 Not very related
 Not related at all
 Unsure
19. Would you share or recommend the
BFWHW Emotional Wellness Guide to
friends or family members?
 I would recommend it to a friend or
family member
 I would not recommend it to a friend or
family member
 Unsure
20. Now that you have been given the BFWHW
Emotional Wellness Guide, are you more or
less likely to talk about your emotional
health and well-being with your doctor,
counselor or another health care provider?
 More likely
 Less likely
 No difference
 Unsure

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. The OMB control number for this project is 0915-xxxx.
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time
for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-33, Rockville, Maryland, 20857.

21. Please write down any other comments you
have about the BFWHW Emotional Wellness
Guide that you would like to share:

22. Would you be interested in more
information about how to improve your
emotional health and wellbeing?
 Yes
 No

Thank you for your participation!

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. The OMB control number for this project is 0915-xxxx.
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time
for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-33, Rockville, Maryland, 20857.

Appendix F:
Consumer Informed Consent Form

F-1

Bright Futures Evaluation: Statement of Informed Consent
The Health Resources and Services Administration, Office of Women’s Health (HRSA OWH) Bright
Futures for Women’s Health and Wellness (BFWHW) program is intended to improve the physical and
emotional health of women of all ages. HRSA OWH contracted with The Lewin Group, a private
consulting firm in Falls Church, Virginia, to conduct an evaluation of this program’s Emotional Wellness
Consumer Guides.
What is the purpose of this evaluation project?
This evaluation project will help the HRSA OWH understand the usefulness of the BFWHW Emotional
Wellness guides for women in their everyday lives.
Why am I invited to participate?
You have been asked to participate in this evaluation project because you receive clinical care or other social
support services at a center or site that is participating in this evaluation project.
What will I be asked to do if I participate?
If you choose to participate, you will be asked to fill out a short survey. It should take you about 15
minutes to finish.
Do I have to participate?
No, taking part in this study is your choice. Your decision will not affect your regular care or the health
care services you receive at this center. If you decide to participate, but then feel uncomfortable at any
time, you can: 1) Choose not to answer a question if it bothers you; 2) Talk to the person who gave you the
survey or your health care provider about how that question made you feel; and/or, 3) Choose not to
continue to fill out the survey.
Are my survey answers confidential?
Yes, your survey answers are confidential. You will not be asked to put your name on your survey. No
information will be collected that could be used to identify you.
What if I am under 18 years of age? May I still participate?
Yes, you may participate with the permission of your parent or legal guardian. You need to sign the Statement
of Consent from Minor Form on page 2 AND your parent or legal guardian will need to sign the Statement of
Consent Form from Parent/Legal Guardian form on page 2.
Are there any negative things that can happen because I participated in the project?
Some of the questions in the survey may make you feel uncomfortable. If you feel uncomfortable at any
time, you can: 1) Choose not to answer that question; 2) Talk to the person who gave you the survey or
your health care provider about how that question made you feel; and/or, 3) Choose not to continue to fill
out the survey.
Will I receive money for participating in this project?
If you complete the survey, you will be given a $10 Visa check card, which works like cash to pay for
groceries, clothing, gas, etc. at places that accept Visa cards.
What do I do if I want to participate?
If you want to participate in the project, please turn to page 2 and sign the consent form. Keep the first
page and return the signed form to the person who gave it to you. That person will give you a survey to
fill out and an envelope that has already been stamped and addressed. You should fill out the survey, seal
it in the envelope and bring it back to the person who gave it to you. You will be given a $10 Visa check
card when you are finished with your survey. The person who gave you the survey will mail your survey
to The Lewin Group without opening it. Or if you prefer to mail the survey yourself, you can take the

F-2

Bright Futures Evaluation: Statement of Informed Consent
sealed envelope with you and drop it in any U.S. Postal Service mailbox and it will be returned directly to
the evaluators at The Lewin Group. If you have any questions or concerns about the survey or this survey
project you should contact Shanise DeMar of The Lewin Group at [1-888-XXX-XXXX].

F-3

Bright Futures Evaluation: Informed Consent Signature Page
The BFWHW program includes health educational materials on different topics for women of all
ages. The BFWHW Emotional Wellness guides have information to help young and adult women feel
good about themselves. The information in the guides can also help women realize the importance of
relationships with other people. This evaluation will help the HRSA OWH understand the usefulness
of the BFWHW Emotional Wellness guides for women in their everyday lives. The evaluation findings
may also help HRSA OWH develop other materials to improve women’s health. If you choose to
participate, you will be asked to fill out a survey that asks you questions about yourself, your emotional
health, and what you think about the BFWHW Emotional Wellness guide (if you have seen it).
STATEMENT OF CONSENT
I ___________________________ have read both pages of the statement of informed
(print name clearly)
consent. I fully understand the information and I am willing to participate in this project.

_____________________________________________
(sign here)

____________________
(date)

-----------------------------------------------------------------------------------------------------------------STATEMENT OF CONSENT FROM MINOR
(If participant is under the age of18)
I ___________________________ have read both pages of the statement of informed
(print name clearly)
consent. I fully understand the information and I am willing to participate in this project.

_____________________________________________
(sign here)

____________________
(date)

------------------------------------------------------------------------------------------------------------------STATEMENT OF CONSENT FROM PARENT/LEGAL GUARDIAN
(If participant is under the age of 18)
I ___________________________ have read both pages of the statement of informed
(print name clearly)
consent. I fully understand the information and I give permission for _________________
(print name of
minor clearly)
to participate in this project.

_____________________________________________
(sign here)

____________________
(date)

Please return this signature page to the person who gave you this informed consent statement.
You may keep the first page (the Statement of Informed Consent) for your own reference.

F-4

Appendix G:
Distributor Survey

G-1

Bright Futures for Women’s Health and Wellness Initiative
Survey for Individuals Distributing the Bright Futures for Women’s Health and Wellness:
Emotional Wellness Guides

DRAFT
Please answer the following questions:
1. Please indicate your sex:
 Male
 Female
2. Please indicate your age group:
 18-24
 25-44
 45-64
 65+
3. Are you Hispanic or Latina?
 Yes
 No
4. Which one of the following would you say is
your race?
 White
 Black
 American Indian or Alaska Native
 Asian
 Native Hawaiian or other Pacific Islander
 Two or more races
5. What is your role in your organization?
 Health care provider
 Counselor
 Social worker
 Outreach worker
 Peer educator/Promotora
 Other________________________
6. What is your primary professional qualification?
 Medical Doctor
 Licensed nurse
 Licensed social worker
 Midwife
 Psychologist
 Licensed Professional Counselor
 Advanced Practice Nurse
 Other ________________________

7. How many years of experience do you have in
your current profession?
 Less than 3 years
 3 – 5 years
 6 – 10 years
 11– 20 years
 More than 20 years
8. What types of services do you provide (check all
that apply)?
 Prenatal care
 HIV/AIDS treatment
 Routine medical care
 Emotional health care
 Social support or case management services
 Other_____________________________
9. Approximately how many individual women do
you see each month?
 1-10
 11-25
 26-50
 More than 50
Please describe the women to whom you provide
services:
10. Approximately what percentage of the women
you see fall into each of these age groups?
Under 18 ____%
18-24 ____%
25-44 ____%
45-64 ____%
65+ ____%
11. Approximately what percentage of the women
you see are in each of these race/ethnic groups?

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. The OMB control number for this project is 0915-xxxx.
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for
reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-33, Rockville, Maryland, 20857.

Hispanic ____%
White ____%
Black ____%
American Indian or Alaska Native____%
Asian____%
Native Hawaiian or other Pacific Islander___%
Two or more races ____%
12. How often do the women you see talk to you
about emotional health issues or concerns?
 Very often
 Somewhat often
 Occasionally
 Rarely
13. What types of emotional health issues or
concerns are most frequently reported to you by
the women you see (check all that apply)?
 Depression
 Family or relationship problems
 Loneliness
 Substance abuse
 Anxiety
 Other ______________________
14. How comfortable are you talking about
emotional health and well-being with the
women you see?
 Very comfortable
 Mostly comfortable
 Somewhat comfortable
 Somewhat uncomfortable
 Very uncomfortable
15. Were you aware of the Bright Futures for
Women’s Health and Wellness (BFWHW)
program or the consumer guides prior to this
evaluation of the guides?
 Yes
 No
16. Did you distribute any of the BFWHW Emotional
Wellness Guide guides prior to this evaluation
of these guides?
 Yes (check all that apply)
___ Physical Activity and Healthy Eating Guides

___ Emotional Wellness Guides
 No
 Unsure
17. Approximately how many women have you
given copies of the BFWHW Adult Woman’s
Guide to Emotional Wellness since this
evaluation of the guides began?
0
 1-25
 26-50
 51-100
 More than 100
18. Approximately how many women have you
given copies of the BFWHW Young Woman’s
Guide to Emotional Wellness since this
evaluation of the guides began?
0
 1-25
 26-50
 51-100
 More than 100
19. To whom and under what circumstances do you
give the BFWHW Emotional Wellness Guides?
 Only to women who express concerns about
emotional wellness
 Only to women who participate in a certain
program or receive a certain type of service.
Please specify: _________________________
_______________________________________
 Most of the women I have seen since the
evaluation began
 All the women I have seen since the
evaluation began
20. When you give women the BFWHW Emotional
Wellness Guides, how extensively do you
usually go through it with them (e.g., explaining,
talking about it, and/or answering questions)?
 I spend a minute or two explaining what it is
and why I’m giving it to them
 I flip through it with them for several minutes
and point out one or two points of interest

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. The OMB control number for this project is 0915-xxxx.
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for
reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-33, Rockville, Maryland, 20857.

 I spend 10 or more minutes walking through
the whole Guide with them and answering
questions
 It varies depending on the circumstance (e.g.
depends on whether the woman raised any
issues of emotional health herself, how
many questions she asks, what type of
appointment)
 Other ___________________________
21. Do you think the Woman’s Guide contains advice
that the adult women you see can use to feel
better about their lives?
 Yes, it contains very useful advice
 Yes, it contains mostly useful advice
 No, the advice is not very useful
 Unsure
 Not applicable (I did not distribute the
Woman’s Guide)
22. Do you think the Young Woman’s Guide contains
advice that the young women (under 18) you see
can use to feel better about their lives?
 Yes, it contains very useful advice
 Yes, it contains mostly useful advice
 No, the advice is not very useful
 Unsure
 Not applicable (I did not distribute the Young
Woman’s Guide)
23. How easy do you find it to explain and talk about
the BFWHW Emotional Wellness Guides to the
women you see?
 Very easy to explain and talk about
 Mostly easy to explain and talk about
 Somewhat easy to explain and talk about
 Somewhat difficult to explain and talk about
 Very difficult to explain and talk about
 I did not distribute the Women’s Guide
24. How relevant do you think the examples and
personal stories in the BFWHW Emotional
Wellness Guides are to the lives of the women
you serve?
 Very relevant
 Mostly relevant
 Somewhat relevant

 Somewhat irrelevant
 Very irrelevant
25. Since you have been distributing the BFWHW
Emotional Wellness Guides, do you discuss
emotional wellness with the women you serve
more often than before?
 Yes, much more often than before
 Yes, somewhat more often than before
 No, no difference
 Unsure
26. Since you have been distributing the BFWHW
Emotional Wellness Guides, have you referred
more women for further emotional health
services (on average)?
 Yes, I have referred many more women for
emotional health services on average than I
did before
 I have probably referred a few more women
for emotional health services on average
than I did before
 No, I have probably referred fewer women
for emotional health services on average
than I did before
 No, no difference
 Unsure
27. Would you recommend these BFWHW
Emotional Wellness Guides to other
professionals in your field?
 Yes
 No
 Unsure
28. Please circle whether you think the following
statements about the BFWHW Emotional
Wellness Guides are True or False:
T/F They are easy for the women I see to read
and understand.
T/F They are culturally appropriate for the
women I see.
T/F They help women to feel more comfortable
talking about emotional health and
wellbeing with me

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. The OMB control number for this project is 0915-xxxx.
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for
reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-33, Rockville, Maryland, 20857.

T/F They help me to feel more comfortable
bringing up issues of emotional health and
wellbeing with the women I see
T/F They are too long.
T/F I often don’t have enough time to discuss
them with the women I see.
29. Do you plan to continue distributing these
BFWHW Emotional Wellness Guides as part of
your routine practice?
 Yes
 No
 Unsure
30. What other types of educational materials or
BFWHW Emotional Wellness Guides would you
find most useful in your practice?

31. Additional Comments:

Thank you for your participation!

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. The OMB control number for this project is 0915-xxxx.
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for
reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-33, Rockville, Maryland, 20857.

Appendix H:
Focus Group Guidance

H-1

Health Resources and Services Administration
Bright Futures for Women’s Health and Wellness (BFWHW) Emotional Wellness
Guides
Consumer Focus Group Guidance
DRAFT
Suggested Intro: Thank you for taking the time to speak with us today. My name is XX and I
work for The Lewin Group, a health care consulting firm in Falls Church, Virginia. We are
working with the Health Resources and Services Administration to evaluate a new set of
educational materials called the Bright Futures for Women’s Health and Wellness (BFWHW)
Emotional Wellness Guides. These materials are designed to provide women with information
about emotional health and wellness.
This focus group will last 1 to 1.5 hours. First, we are going to give you a chance to review the
BFWHW Emotional Wellness Guide, and then we will ask you some questions about the
BFWHW Emotional Wellness Guide. You have been invited to participate today because we
want your feedback on the BFWHW Emotional Wellness Guide, how useful you think it is,
whether it talks about issues that are important to you, and whether or not you would
recommend it to other women. We’ll ask you questions like “Was the BFWHW Emotional
Wellness Guide easy to read and understand?” and “Is the advice helpful?” We’ll also ask you
questions about how comfortable you are or might be talking about the issues in the BFWHW
Emotional Wellness Guide with your health care provider, counselor, or case manager. Your
input and feedback will help us to evaluate the Guide and help the Health Resources and
Services Administration to develop other educational materials to improve women’s health.
Once you’ve reviewed the BFWHW Emotional Wellness Guide, we have some specific
questions we would like you to answer, but feel free to jump in at any time with your thoughts
and ideas. There will be no formal breaks. However, feel free to get up at any time if you need
to stretch, go to the bathroom, or step out for a moment.
We hope you will be as open and honest with us as possible, and we ask that everyone keep
what is said here today confidential. We are taping this session and taking notes so we can
compile all of your feedback together along with feedback from women we are talking with at
other sites, but your individual answers or comments will not be shared with anyone outside
this evaluation team. Your comments and answers will not be linked to you and your name will
not be used in the final evaluation report. We value the information you will share with us
today and want to make sure we accurately capture all of it, which is why we’d like to tape the
session. Does anyone have any objections to us taping this discussion?”
Please understand that your participation is entirely voluntary and does not affect the care that
you will receive from [insert name of site/program]. You are free to decide not to answer any of
our questions and to quit participating altogether and leave at any time. At the end of this focus
group, you will be given a $10 Visa check card as a token of our appreciation. The $10 Visa
check card works like cash to pay for groceries, clothing, gas, etc. at places that accept Visa
cards.

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Do you have any questions before we begin?
Review Guides: Participants will have 10-15 minutes to read through the guide. Notepads will
be provided so they can take notes if desired.
Questions (in round table format):
1)
2)
3)
4)

Overall, what did you think about the BFWHW Emotional Wellness Guide?
Is it easy to read?
Is it easy to understand?
What did you think of the examples?
a. Did the women’s stories/experiences/challenges seem familiar to you?
b. Can you relate to any of them? Have you experienced similar things?
c. Do you feel the Guide was written for women like you?
5) What did you think about the advice and tips in the guide?
a. Is it good advice? Is it helpful?
b. Were some of the ideas new to you? Is the Guide suggesting some things you do
anyway?
6) Do you think the BFWHW Emotional Wellness Guide is useful or helpful?
a. If so, what is most useful or helpful about it?
b. If you do not think the guide would help you, do you think the advice would
help other women? Who do you think the Guide would be helpful for?
7) Do you ever talk about issues like these (relationships, self-confidence, life balance) with
your friends or family members?
8) Have you ever talked about issues like these with your health care provider or counselor
here or elsewhere?
a. If so…
i. Did the provider or counselor ask you about something or did you raise
the issue yourself?
ii. Was it helpful to talk about it?
iii. Did the provider or counselor seem comfortable talking about it?
iv. Were you comfortable talking about it?
b. If not…
i. Why not? (e.g., no issue so nothing to talk about, wanted to but didn’t
feel comfortable, or didn’t have time in the appointment, etc.)
9) If someone gave you this BFWHW Emotional Wellness Guide in an appointment, would
you be more likely to talk with them about these issues?
10) Do you think this BFWHW Emotional Wellness Guide might help other women to feel
more comfortable talking about these issues with their health care providers?
11) Would you recommend this BFWHW Emotional Wellness Guide to your friends or
relatives?
12) Do you have any other comments or suggestions to make?

H-3

Appendix I:
Sample Evaluation Report #1

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I. INTRODUCTION
A. Overview
This Outcome Evaluation report is the final in a series of evaluation reports produced by
The Lewin Group (Lewin) as part of a three-year external evaluation of The California
Endowment’s Mental Health Initiative (MHI). The purpose of this final summative report is
to present findings, at the overall MHI level, on the outcomes, accomplishments, and
contributions of the MHI over the three-year grant period.
B. Data Sources and Methods
Findings presented in this report are from three primary data sources: (1) semi-annual
surveys; (2) updated program monitoring matrices (PMMs); and (3) site visits. Lewin used
the method of triangulation to analyze these data. Specifically, we used the PMM data to
identify grantee progress in achieving outcomes and then identified, compared, and
validated in more depth key findings using the survey results. The site visits provided an
opportunity to gather grantee-specific experiences and outcomes not captured by the PMMs
and surveys.
•

Semi-Annual Surveys. Lewin administered five targeted evaluation surveys during the
course of the three-year funding period: one in July 2002, a second in January 2003, a
third in July 2003, a fourth in January 2004, and a final survey that was administered to
coincide with each grantee’s program end date. This final survey was administered only
to those grantees that had been approved for a no-cost extension. The surveys captured
detailed organizational descriptive and progress information and covered various topic
areas including: culturally competent service delivery, partnerships/networking,
outreach, community involvement and impact, policy relevance, leadership, stigma, and
sustainability. In this report, we use survey data to investigate and validate key
outcomes achieved and promising practices.

•

Updated Program Monitoring Matrices (PMMs). Information obtained from grantee
applications, progress reports, and final reports were another important data source for
this report. Lewin systematically reviewed grantees’ applications, September 2001
progress reports, March 2002 progress reports, September 2002 progress reports, March
2003 progress reports, September 2003 progress reports, and grantees’ final reports, and
compiled the information into a spreadsheet database referred to as the Program
Monitoring Matrices (PMMs). PMMs include information for each grantee on the
organizational structure and environment; inputs and resources; target population;
interventions; expected changes; evidence of changes; barriers; facilitators; and progress
towards implementing interventions and achieving both anticipated and unanticipated
outcomes.
To analyze the 46 PMMs, Lewin used the technique of open-coding to process
information on interventions, outcomes, barriers, facilitators, and changes (progress)
across the time of applications, progress reports, and final reports. These codes were
then entered and analyzed in Microsoft Access.

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•

Site Visits. Qualitative data gathered during site visits were a third source of data for
this outcome evaluation report. During March through June of 2004 and again in the fall
of 2004, Lewin conducted site visits to 40 of the 46 grantees. Of the remaining six
grantees, phone calls were conducted for three of them, and the other three grantees
were not contacted because their programs had ended and staff had disbanded. During
the visits, the site visit team met with the key program, organization, and evaluation
staff, as well as collaborative partners and other stakeholders including clients,
consumers, members of the target community, community-based organizations, other
system providers, and policymakers. Information on the achievement of outcomes,
lessons learned, sustainability strategies, and the effectiveness and impact of the MHI
was collected. After the site visits, the team examined findings across site visit
experiences to surface outcome themes for this report.

C. Data Limitations
The data used for this report are rich, but limited. The PMMs are based on progress and final
reports that consist of information grantees elected to report to The Endowment. The semiannual surveys are self-reported data with the same potential for bias. However, the surveys
provide more specific information on implementation progress and achievement of outcomes
by allowing grantees to report on other key performance indicators. An important limitation
of the surveys is that they only reflect grantees’ perspectives on their programs’ progress and
outcomes and do not capture the perspectives of external stakeholders (e.g., consumers,
families, community leaders, or policy makers). To counter this data limitation, stakeholder
perspectives were gathered during the site visits. A limitation of the site visits was the lack of
information gathered about “hard evidence” of outcomes achieved by grantees. This was a
product of grantees’ evaluation strategies, many of which did not focus on obtaining “hard
evidence” of outcomes, as well as the longer time horizon needed to detect evidence for
certain outcomes, especially mental health and substance abuse outcomes.
II. GRANTEE ORGANIZATIONAL AND PROGRAM CHARACTERISTICS
Findings presented in this section are based on data from the semi-annual surveys and describe
grantee program services and client characteristics from the Initiative’s inception to its end.
MHI Program Services. Over the course of the MHI’s three-year grant period, grantees offered
a variety of program services to their clients. According to survey results, the majority of
grantees (87%) reported providing direct service delivery. Grantees also educated providers
and communities with MHI funding. Almost two-thirds of the grantees (59%) engaged in
provider-centered training, and more than half (52%) conducted community education.
From grant inception to grant end, more than 145,000 individuals received services from or
participated in activities (e.g., education programs, training sessions) sponsored by the 46
grantees. The total number (54,000) of individuals served exceeded grantees’ expectations by
almost threefold. Exhibit 1 shows the expected versus actual distributions of unduplicated
individuals served by service type across the 46 grantees for the duration of the MHI.
Exhibit 1

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Expected vs. Actual Number of Clients Served by Service Type1
(across the 46 grantees for the duration of the MHI)

50,000
45,000
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
0
Direct
Service
Delivery

Provider
Training

Expected Clients Served

Community
Education

Other*

Actual Clients Served

*Other services include cultural competency trainings, promotores trainings, community outreach, public service
announcements, consultations, and referrals to intensive mental health services.

Demographics of Populations Served by MHI Programs.2 The diversity of clients served by
the MHI grantees reflects the demographic composition of California. There were no “typical”
users of the services provided through MHI funding. More than three-quarters (76%) of
individuals served were female, and over half (57%) of the individuals served were adults
between the ages of 23 and 54. Exhibit 2 presents the age distribution of unduplicated
individuals served from grant inception to grant end.

Breakdown of service type is provided for those grantees who reported service type data in their most recently
completed survey.
2 Breakdown of demographic data is provided for those grantees who reported gender, age, and race/ethnicity in
their most recently completed survey.
1

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Exhibit 2
Distribution by Age
(unduplicated individuals served for the duration of the MHI)
Age Distribution

Total Number

Percent

0-5

1,032

6-12

1,194

13-17

9,056

22%

18-22

2,009

23-54

23,508

57%

55+

4,137

10%

TOTAL

40,936

100%

Exhibit 3 profiles the distribution of unduplicated individuals by race/ethnicity served from
MHI inception to grant end. Latinos comprised more than half (56%) of those served.
Exhibit 3
Distribution of Race/ Ethnicity
(unduplicated individuals served for the duration of the MHI)
Race/Ethnicity

Total Number

Percent

Latino

23,387

56%

Asian

5,260

13%

White

4,559

11%

African American

4,261

10%

American Indian

3,714

Other African

362

Other

101

41,644

100%

TOTAL

Almost half (45%) of the individuals served spoke English as their primary language. The
remaining half (45%) of the individuals served were monolingual, non-English speaking
individuals. An additional 10 percent were bilingual, with 6 percent receiving services in
English and 4 percent receiving services in their native language.
Staffing Composition of MHI Programs. At the end of the Initiative, a total of 334 individuals
were employed by the MHI grantee organizations. Almost three-quarters (72%) of these
individuals were female and half (52%) were bi-lingual. Forty-one percent held clinical
positions, nearly a quarter (21%) served as consultants or evaluation specialists, 24 percent were
support staff, and 14 percent served as Program Directors.

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From grant inception to grant end, the MHI grantees hired a total of 264 new staff (i.e., a person
from within or outside the organization hired specifically for the MHI grant program). Out of
the total number of new hires, more than a third (37%) were “home grown” (e.g., community
members or staff promoted from within the organization who received informal or formal
training or other supports to effectively function in the new position). The large percentage of
“home grown” staff reflects the difficulty grantees faced with recruiting and hiring qualified
mental health professionals to staff their programs.
Insurance Status of Populations Served by MHI Programs.3 Exhibit 4 presents the distribution
of MHI clients served during the Initiative by health insurance status. Of the individuals for
whom insurance status was reported, more than half (51%) were uninsured, an indication that the
MHI filled health insurance coverage gaps for vulnerable populations in California.
Exhibit 4
Distribution of Health Insurance Status
(unduplicated individuals served for the duration of the MHI)
Type of Insurance

Total Number

Percent

Uninsured

4,474

51%

MediCal

2,511

28%

MediCal/Medicare

1,068

12%

Private Insurance

549

Medicare

287

8,889

100%

TOTAL

Mental Health Status of Populations Served by MHI Programs.4 As shown in Exhibit 5,
clients served with MHI funding presented with a range of mental health conditions. The top
three presenting diagnoses were family dysfunction, mood disorder, and interpersonal
problems. It is important to note that although family dysfunction was the most prevalent
diagnosis, this proportion was driven in large part by one grantee intervention that addressed
family dysfunction through large community meetings.
Exhibit 5
Distribution of Individuals by Diagnosis (n=13,151)

Type of Diagnosis/Condition

Total Number

Percent*

Breakdown of insurance status is provided for those grantees who reported insurance status in their most recently
completed survey.
4 Breakdown of mental health status is provided for those grantees who reported mental health diagnosis in their
most recently completed survey.
3

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Family Dysfunction5
Mood Disorder
Interpersonal Problems6
Emotional Disturbance
Physical Ailments7/ Chronic Illness
Substance Abuse
Dual Diagnosis8
Other9
Thought Disorder

9,653
5,076
3,421
3,144
2,645
2,017
1,706
1,441
379

73%
39%
26%
24%
20%
15%
13%
11%
3%

*Percentages exceed 100% because individuals could have had more than 1 diagnosis.

III. OVERVIEW OF GRANTEE IMPLEMENTATION
This section of the report provides an overview of the progress the MHI grantees made in
implementing their programs during the three-year grant period, as well as the barriers and
expeditors that influenced implementation. Findings are organized into four subsections: 1)
most common types of interventions and goals grantees had expected to implement and
achieve; 2) grantee achievement by type of goal; 3) implementation barriers; and 4)
implementation expeditors. Findings reported in this section are based primarily on data from
grantees’ applications and progress and final reports.
A. Grantee Planned Interventions and Goals
Review of Planned Interventions. Grantees planned to implement a broad range of
interventions. Based on grant applications and progress reports, the majority of grantees planned
to conduct activities associated with 1) infrastructure and capacity building (100%); 2) provider,
consumer, and community training and education (93%); 3) community outreach (91%); 4) direct mental
health service delivery (91%); and 5) sustainability (89%).
For each broad intervention type, grantees planned to conduct a variety of related activities.
For example, for infrastructure and capacity building, grantees planned to recruit and hire staff,
establish coalition and advisory boards, and prepare or lease a facility or purchase equipment.
For training and education of providers, consumers and community members, grantees had planned to
conduct general training workshops, provide culturally and linguistically competent trainings
(including mental health training), and develop or purchase training materials. Exhibit 6 lists

Family dysfunction refers to individuals who experience problems within their family unit, including domestic
violence, child abuse, and neglect.
6 Interpersonal problems refers to individuals who experience behavioral and social problems such as mental health
conditions, substance abuse, and uncontrollable anger that impair their ability to have healthy and cooperative
relationships with others.
7 Physical ailments refer to individuals presenting with psychosomatic symptoms.
8 Dual diagnosis refers to individuals with both emotional/psychiatric disturbance and substance abuse problems or
diagnosed developmental disabilities.
9 Other refers to individuals with confronting mental health issues such as family and domestic violence, end-of-life
issues, and trauma.
5

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the most commonly reported activities grantees planned to conduct for the top five intervention
types.
Exhibit 6
Most Commonly Planned Intervention Sub-Activities
1.

Intervention Type
Infrastructure and
capacity building
Training and
education of
providers, consumers
or community
Community outreach

Direct mental health
service delivery to
consumers and
families
Sustainability

Most Common Intervention Sub-Activities
Recruit and hire staff
Establish coalition and advisory boards
Prepare or lease a facility/Purchase equipment
Conduct general training workshops for providers, consumers,
program staff, and the community
Provide culturally and linguistically competent trainings,
including mental health training, for providers
Develop or purchase training materials
Disseminate information in various media formats (e.g., bilingual
flyers, newsletters, advertisements on local radio/TV stations)
Conduct community forums and focus groups
Collaborate with local community organizations (e.g., school
system, churches, youth organizations, social service providers)
Individual, family and group therapy/counseling
Referrals and linkages, including transition planning for
disenrollment
Clinical consultations
Case management services
Leverage state funds or private funds
Conduct fundraising events

Review of Planned Goals. The MHI grantees expected to achieve a broad range of goals
through their planned interventions. The majority of grantees specified five types of goals: 1)
increasing access to services (93%); 2) providing services to culturally diverse and underserved
populations (93%; 3) enhancing program implementation capacity (89%); 4) achieving sustainability
(89%); and 5) increasing community collaborations and partnerships (83%). Exhibit 7 shows the most
commonly planned grantee achievements by the top five types of planned goals.

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Exhibit 7
Most Commonly Planned Program Goals and Activities/Achievements
1.

Goal Type
Strategies for
increased access to
services
Service provision

Increased capacity to
implement program

Program achieves
sustainability
Increased
collaboration and
partnership with
community

Most Common Activities/Achievements
Recruit/hire staff
Provide enabling/support services (e.g., child care services,
transportation, housing assistance)
Provide individual, family, and group therapy/counseling
Make referrals and linkages, including transition planning for
disenrollment
Provide clinical consult or intake
Provide skill-building training
Train staff
Develop partnerships/Sign contracts
Increase client recruitment into the program
Convene advisory or governance meetings
Secure reimbursement or other revenue
Develop sustainability plan
Establish advisory board or committee
Increase coordination of services among the collaborative
partners
Secure involvement of community stakeholders in governance,
treatment planning, or program and policy planning

B. Implementation Goal Achievement
By the end of the MHI three-year grant period, grantees achieved or exceeded several of their
expected goals. In this section, achievement by goal type is only reported for those grantees that
planned to achieve that particular goal. As Exhibit 8 shows, the majority of grantees reported
achievement of goals related to service provision; increased capacity to implement their
programs; increased education/knowledge/awareness among CBOs, local providers and
families of mental/behavioral health and cultural issues; increased quality of services; and
improved mental health and substance abuse outcomes among their clients. Section IV of this
report provides more detailed information on the achievement of goals by the MHI grantees.
Exhibit 8
Grantee Achievement by Type of Goal
Total Number
of Grantees
Planning to
Achieve Goal
Type

Number of
Grantees Who
Achieved or
Exceeded Goal

Percent of
Grantees Who
Achieved or
Exceeded Goal

Service provision

77%

Increased capacity to implement program

71%

Type of Goal

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Total Number
of Grantees
Planning to
Achieve Goal
Type

Number of
Grantees Who
Achieved or
Exceeded Goal

Percent of
Grantees Who
Achieved or
Exceeded Goal

Increased education/knowledge/awareness among
CBOs, local providers and families of
mental/behavioral health and cultural issues

71%

Increased quality of services

67%

Improved mental health and substance abuse
outcomes

62%

Increased education/knowledge/awareness of
program/model among CBOs and local providers

58%

Improved functioning

56%

Strategies for increased access to services

53%

52%

Reduced stigma associated with mental illness

46%

Development and implementation of culturally
competent services

44%

Increased client satisfaction

43%

Improved effectiveness of health system

42%

Development of effective evaluation methods

40%

Program achieves sustainability

37%

Development, implementation, or replication of best
model/best practice

19%

Type of Goal

Increased collaboration and partnership with
community
Increased number served from baseline (increased
utilization and enrollment)

C. Implementation Barriers
During the implementation of their programs, the MHI grantees faced several barriers that
affected the implementation of interventions and achievement of program goals. Exhibit 9 lists
the most common barriers reported by grantees from grant inception to end, including staffing
difficulties; barriers to reaching the target population; and logistical barriers.
Exhibit 9
Most Common Barriers Reported by Grantees
(for the duration of the MHI)
Type of Barrier
Staffing

Number of
Grantees
43

Percent of
Grantees
93%

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Number of
Grantees
39

Percent of
Grantees
85%

Logistical Barriers

72%

Limited Infrastructure

67%

Financing/Budgeting

63%

Difficulty Maintaining Partnerships

59%

Stigma

57%

Difficulty Providing Needed Services

52%

Difficulty Identifying Best
Practices/Evaluation Methods

43%

Community Resistance

26%

Difficulty in Establishing Confidentiality
Agreements

Type of Barrier
Barriers to Reaching the Target Population

Staffing. Over the course of the MHI, grantees reported staffing difficulties as the greatest
barrier encountered. Staffing barriers included difficulty recruiting staff members with the
right mix of skills, experience, degrees, and cultural competence to fit position requirements.
For example, one grantee reported a substantial delay in implementation because it took several
months to recruit and hire culturally and linguistically appropriate clinical providers to staff the
program’s various public health clinics. Another staffing barrier concerned the inability of the
programs to offer competitive salaries. For example, the most daunting task throughout the
course of the grant period for one grantee was identifying, recruiting, hiring and maintaining a
Masters-level, bilingual mental health counselor. Despite more than five months of aggressive
marketing and searching, the program was able to fill the position only after increasing the
salary by 30 percent.
Barriers to Reaching the Target Population. Many grantees also experienced problems
successfully reaching their target populations. Many of the MHI target populations did not
traditionally seek mental health services or even recognize mental health issues as treatable
concerns. For example, the greatest challenge for staff at one grantee program was finding
ways to engage the families of clients in therapeutic support. The families of the at-risk clients
were suspicious of mental health providers and those they identified as part of “the system.”
Moreover, many of the families experienced multiple stressors, such as: financial difficulties,
legal problems, mental and physical health concerns, and substance abuse issues making it
difficult to engage competing priorities. Cultural differences also made trust and engagement
difficult to achieve.
Logistical Barriers. Program implementation was affected by several logistical barriers,
including: limited hours of operation, lack of transportation for clients, lack of coordination of
services, lack of community participation due to geographic isolation, and other
implementation and start-up setbacks such as a lack of translated materials. For example, one
grantee did not have enough time or funding to establish the infrastructure or to train clinical
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staff for integrating mental health services into primary care. As a result, the referral process
from the primary care department to the mental health department was not fully operational
until much later in the grant period, delaying proper coordination of services for clients.
Limited Infrastructure. Challenges related to limited space and program capacity were another
common barrier faced by grantees over the course of the Initiative. One grantee had difficulty
offering and conducting large group sessions due to renovations that forced groups to be held
in smaller rooms. Another grantee struggled with locating space for confidential therapy
sessions and often had to use employees’ offices to ensure client privacy. The grantee provided
extended service hours on the weekdays and also offered counseling sessions on Saturdays to
ensure that clients received the services and care they needed in a confidential manner.
Difficulty Identifying Best Practices/Evaluation Methods. Twenty grantees experienced
difficulties identifying best practices and evaluation methods. For example, for one grantee, the
greatest challenge encountered was determining how to evaluate the efficacy of their program
through patient outcomes. The program had difficulty identifying specific behavioral
indicators that would provide evidence for the effectiveness of mental health services provided
to patients. It was also difficult for the program to assess each patient using self-report
instruments because these tools were not readily available in Thai, Khmer and other languages.
to reconcile the need to evaluate patient outcomes with the time and resources the program had
available, program staff decided to implement a provider assessment survey in which the
provider (not the patient) assessed patient outcomes.
D. Implementation Expeditors
Although grantees faced barriers during the course of the MHI that impeded implementation
and achievement of goals, they also encountered expeditors that supported delivery of program
services. Exhibit 10 lists the most common expeditors experienced by grantees from grant
inception to grant end. The greatest number of grantees reported that knowing and responding
to the needs of their target populations; highly qualified staff; and effective partnerships and
collaborations were expeditors for program implementation.
Exhibit 10
Most Common Expeditors Reported by Grantees
(for the duration of the MHI)
Type of Expeditor

Number of
Grantees

Percent of
Grantees

Knowing and Responding to the Needs of
the Target Population

93%

Qualified Staff

87%

Effective Partnerships and Collaborations

87%

Accessibility of Services

57%

Improved Infrastructure

57%

Activities to De-Stigmatize Mental Illness

46%

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Knowing and Responding to the Needs of the Target Population. Knowledge of their
communities and responding to the needs of their target populations greatly facilitated the
implementation of grantee programs. Strategies programs used to respond to target
populations included finding ways to accommodate clients and providing clients with
incentives to participate in the program. For example, recognition of transportation issues led
to offering community-based programs, often located in the actual neighborhoods where the
target populations resided. In terms of offering clients incentives to participate in the program,
grantees used a range of strategies, including offering clients meals, child care services, and
transportation vouchers. According to survey data, more than three-quarters (82%) of grantees
responding to the final survey reported that they took into account the input of clients and the
local community in the development, design, and delivery of their program services. About
two-thirds (65%) of the grantees reported that they also responded to input received from
families.
Employing Qualified Staff. Although grantees encountered challenges finding qualified staff,
they benefited from the skills and expertise of their program staff once appropriate people were
identified and hired. For example, hiring staff persons knowledgeable of community resources,
culture, and language enhances client engagement, the referral process, and the development of
productive and lasting relationships with partner organizations. Employing staff with specialty
expertise, such as knowledge of the dynamics of domestic violence or children’s behavioral
issues, enhanced the ability of many programs to integrate mental health programming into
other environments (e.g., schools, primary care, etc.) because professionals in those settings
recognized the value of this specialized knowledge in better serving the needs of their clientele.
Maintaining Effective Partnerships and Collaborations. Several grantees also identified
effective partnerships and collaborations as assisting in providing valuable resources, program
implementation, and goal achievement. For example, one grantee reported that a strong
working relationship with partners enabled them to establish effective communication with
high school staff to obtain releases of students from class to attend therapy services. Another
grantee developed strong collaborative relationships with major mental health providers and
city and county agencies, which enabled the smooth transition of clients between the program
and other community agencies. The effective partnerships also resulted in expedited referral
processes and the availability of improved case management services for the program’s clients.
Other Implementation Expeditors. When surveyed, grantees cited other program
implementation facilitators, including: service accessibility (e.g., integrating services into host
settings or communities), infrastructure development, de-stigmatizing mental health, word-ofmouth referrals, and modifications/accommodations for screening, assessment, and
administrative activities. At one grantee program, clients accessing services referred family and
friends, resulting in more walk-in clients and people calling the agency to inquire about mental
health services. In this instance, the grantee had to scale-back their outreach due to the
increased number of clients accessing services as a result of word-of-mouth referrals.
Modification of assessment tools was an important strategy for limiting burden on clinical staff,
as well as clients. Several programs modified assessment tools for quicker and more accurate
completion by clinicians to enable them to spend more time in therapy with clients. Other
accommodations for clinical staff included reminders for when the assessment measures were
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due, trainings on how to complete the assessment forms, and offering clinicians quarterly
“client free” days to review charts and complete paperwork.
IV. INDIVIDUAL PROGRAM ACCOMPLISHMENTS
This report section describes grantees’ accomplishments in achieving individual program goals
and outcomes. Findings presented in this section are derived from grantee progress and final
reports, semi-annual surveys, and site visit data.
A. Increasing Access to Mental Health Services
Most grantees (n = 43)planned to increase access to mental health services by reaching
underserved populations that historically have not accessed the continuum of mental health
services. Of the 43 grantees targeting access issues, 23 (53%) reported achieving or exceeding
this goal. Exhibit 11 presents the specific goals grantees successfully achieved related to
increased access to mental health services.
Exhibit 11
Types of Goals for Increasing Access to Mental Health Services
Number of
Grantees
Planning to
Achieve
Goal
(Total = 43)*

Number of
Grantees Who
Achieved or
Exceeded Goal

Percent of
Grantees Who
Achieved or
Exceeded
Goal

Specific goals related to increasing access to
services, such as integration and policy change

60%

Provide services in closer proximity to target
population/ in a familiar setting/ in a nontraditional setting

43%

Recruit/hire appropriate staff

39%

Provide enabling/adjunctive/support services

10%

Types of Goals

*Goals are not mutually exclusive across the 43 grantees.

The MHI grantees met an unfulfilled need in the community, as reflected by the more than
145,000 individuals that were served during the course of the Initiative. The grantees were so
successful in increasing access to services that the demand for services, in many cases,
surpassed the supply. According to the survey data, almost half (45%) of the grantees reported
that they had a waiting list for individuals to receive services at any time during the three-year
grant period. Of those grantees with waiting lists, the average length of time for clients on the
waiting list before receiving services was 24 days.
Goals Specific to Increasing Access. Nearly two-thirds of the grantees with specific goals
related to increasing access achieved or exceeded their goals by changing administrative
policies, such as automatic referral to mental health services after completing primary care
appointments. This significantly increased the number of patient referrals for mental health
services. Prior to implementing MHI programs focused on integration, associated primary care
providers were reluctant to refer their patients to mental health services. Mental health service
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supply was another access issue affecting referrals from primary care. For example, one grantee
program reported that while primary care providers at the health clinics were skilled in
identifying and diagnosing behavioral health issues, they were restricted by limited availability
and access to behavioral health services for their patients. The MHI-funded project alleviated
this constraint by hiring additional behavioral health staff, increasing the number of hours of
behavioral health services provided on-site at the health clinics, and by creating a more
integrated system of care. As a result, the grantee was able to increase the number of primary
care clients who accessed needed behavioral health services at the health clinics to 415
unduplicated clients.
Services in Close Proximity to Target Population. Grantees also increased access to mental
health services by providing services in close proximity to the target population and in familiar,
comfortable settings. For example, one grantee, whose target population was very young highrisk children and their families, provided services in the children’s natural setting – in preschool
and at home. The grantee placed mental health professionals at early education centers and
served children without a formal mental health diagnosis. These children would not otherwise
have received mental health services and would have been unprepared for school and remained
at high-risk for school failure. By providing services in a familiar and comfortable setting in
close proximity to their target population, the grantee was able to provide mental health access
to over 5,500 children and their families. In addition, the program received 307 referrals;
approximately 70 percent of these children received intensive mental health interventions.
Recruiting and Hiring Appropriate Staff. Recruiting and hiring the appropriate staff was
another strategy used by grantees to achieve the goal of increasing access to mental health
services. For example, one grantee trained residents of the community to become promotores to
conduct outreach for the program. Building on their experience as community members, the
promotores had strong existing relationships with residents, spoke their language, and could
relate to the specific issues affecting the community. Through their various outreach activities,
the promotores helped to refer 769 clients for counseling services. From grant inception to
grant end, client intake at the grantee’s counseling center increased by 114 percent.
B. Reducing Stigma
Only 13 grantees explicitly reported plans or intentions to reduce the stigma associated with
accessing and receiving mental health services. However, from site visit data and survey
responses, almost all of the MHI grantees recognized stigma as a major factor affecting mental
health service access and saw the elimination of stigma as an implicit mission of their
organization.
Of the 13 grantees with specific goals to reduce stigma, six (46%) reported achieving or
exceeding this goal. Exhibit 12 presents the specific goals grantees were able to achieve related
to reducing stigma.
Exhibit 12
Types of Goals for Reducing Stigma
Types of Goals

Number of
Grantees

Number of
Grantees Who

Percent of
Grantees Who

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Planning to
Achieve
Goal
(Total = 13)*

Achieved or
Exceeded Goal

Achieved or
Exceeded
Goal

Increase awareness of mental illness and prevention
strategies

50%

Education to county mental health leaders about
effects of stigma on mental health service access

33%

Provide non-stigmatizing services

33%

*Goals are not mutually exclusive across the 13 grantees.

Increasing Awareness of Mental Illness and Prevention Strategies. The most successful
strategy used by grantees to reduce the stigma associated with accessing and receiving mental
health services was increasing awareness of mental illness and prevention strategies. Of the
eight grantees targeting this goal, half were successful. For example, one grantee conducted
focus groups to determine the priority mental health issues facing both the Thai and
Cambodian communities. Focus group results were used to develop educational brochures on
depression, generalized anxiety disorder, and post-traumatic stress disorder, which were then
translated into Thai and Khmer. The brochures were disseminated to the Thai and Cambodian
communities and helped to increase awareness and knowledge of mental illness and prevention
strategies. In addition, program staff published articles about mental illness in local Thai and
Cambodian newspapers, reaching an average readership of 10,000 people in the Thai
community and 2,000 in the Cambodian community. Another grantee increased awareness of
mental health symptoms and disorders among the low-income, underserved Latino population
through the use of radio advertisements, talk shows, and community meetings. The program
held over 20 culturally sensitive workshops/community forums on mental health issues and
service availability and developed and disseminated 36 public service announcements, which
were aired approximately 25 times per month for four years.
Education and Service Provision to Reduce Stigma. As Exhibit 12 shows, two grantees were
successful in reducing stigma: one through educating county mental health leaders about the
effects of stigma and the other through the provision of non-stigmatizing services. In educating
County mental health leaders, the grantee provided information on how to reduce the
community’s anxiety about accessing mental health treatment. The other grantee provided 103
families (358 individuals) with mental health counseling in an informal, group setting. By
providing services in a non-stigmatizing setting, families were comfortable talking openly and
positively about mental issues and concerns with the therapist.
C. Providing Culturally Competent Care
An important accomplishment of the MHI in providing culturally competent care is the
diversity of staff employed across the 46 grantee organizations. Exhibit 13 illustrates this
diversity by comparing the racial/ethnic profile of staff participating in Initiative programs to
the clients served. The racial and ethnic composition of staff employed by the MHI grantees
closely matched that of the clients served.

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Exhibit 13
Distribution of Race/Ethnicity for Clients Served Compared to the
Distribution of Race/Ethnicity for the MHI Staff 10
Clients

Race/Ethnicity

1%
10%

13%

56%

11%
9%

Staff
2%
0%
10%
31%

15%

33%

Clients

Staff

Latino

56%

31%

American Indian

White

11%

33%

Asian

13%

15%

African-American

10%

Other African

Other

41,644

334

TOTAL

In addition to hiring racially and ethnically diverse staff to help provide culturally competent
care to their clients, the MHI grantees also hired staff who were bilingual in the languages
spoken by their target populations. Exhibit 14 reflects the MHI staff’s cultural competence by
comparing language-speaking status of the staff to the clients served across the Initiative.
Exhibit 14
Distribution of Individuals Served by Language-Speaking Status Compared to the
Distribution of the MHI Staff by Language-Speaking Status
Language-Speaking Status

Clients

Staff

English

45%

48%

Monolingual

45%

Bilingual

10%

52%

Goals for Providing Culturally Competent Care. More than half of the grantees (n = 25)
planned to provide culturally competent care. Of the 25 grantees that had planned to achieve
this outcome, 11 grantees (44%) reported that they achieved or exceeded their goal. Exhibit 15

Breakdown of race/ethnicity data is provided for those grantees who reported race/ethnicity of clients and staff in
their most recently completed survey.

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presents the specific goals grantees were successful in achieving related to the provision of
culturally competent care.
Exhibit 15
Types of Goals for Providing Culturally Competent Care
Number of
Grantees
Planning to
Achieve
Goal
(Total = 25)*

Number of
Grantees Who
Achieved or
Exceeded Goal

Percent of
Grantees Who
Achieved or
Exceeded
Goal

Provide cultural competence training to providers

67%

Recruit/hire bilingual staff

40%

Decrease cultural barriers to services/increase
access to culturally competent services

29%

Integrate cultural competence into project

20%

General goals related to providing culturally
competent care

13%

Types of Goals

*Goals are not mutually exclusive across the 25 grantees.

Training Providers in Cultural Competence. The majority (67%) of grantees were successful in
achieving the goal of providing culturally competent care to their clients through the provision
of cultural competence trainings for providers. For example, one grantee provided six cultural
competence training sessions to 80 early childhood providers. The topic of cultural competence
was also widely discussed in supervision groups and in other formal (classroom) and informal
(time outside/after class) settings.
Recruiting and Hiring Bi-Lingual Staff. Recruiting and hiring bilingual staff was another
strategy grantees used to provide culturally competent care to clients. For example, at one
grantee program, culturally competent bilingual staff were able to provide 100% of their clients
with language-appropriate services. Language appropriate services were a critical part of the
project given that 60% of the grantee’s clients were monolingual Spanish speakers and 34% of
clients spoke English as their primary language, but lived in a Spanish-speaking home.
Decreasing Cultural Barriers to Services. Decreasing cultural barriers to services was another
effective strategy for providing culturally competent mental health services. For example, one
grantee reduced the cultural barriers to mental health services for their target population
(Latinos) by meeting with the program’s Advisory Committee and County Mental Health. The
staff discussed how to improve outreach to the community in order to increase the penetration
rate of Latinos receiving County Mental Health services, identified the most significant cultural
barriers to services, and formulated strategies to reduce them. Many of the identified barriers
were addressed through the grantee’s family education classes. In addition, improved
relationships and collaborative practices between the grantee program and County Mental
Health helped to increase access to culturally competent services for clients and their families.
D. Improving Mental Health Outcomes

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Almost three-quarters of the grantees (n=34) planned to improve the mental health outcomes of
their clients. Of the 34 grantees that planned to achieve this outcome, 21 (62%) reported that
they achieved or exceeded their goal. Exhibit 16 presents the specific goals grantees were able
to achieve related to improving the mental health outcomes of their clients.
Exhibit 16
Types of Goals for Improving Clients’ Mental Health Outcomes
Number of
Grantees
Planning to
Achieve
Goal
(Total = 34)*

Number of
Grantees Who
Achieved or
Exceeded Goal

Percent of
Grantees Who
Achieved or
Exceeded
Goal

Measuring improvements in mental health
outcomes

64%

Improve living skills/social competencies

56%

Increase sense of empowerment to deal with mental
health/substance abuse issues

43%

Reduce stress

40%

Increase self-esteem

33%

Decrease incidence of (untreated) mental illness

33%

Decrease incidence of harm to self and/or others

33%

Increase emotional function

29%

Reduce depression/suicide rates

29%

Improve quality of life

25%

Reduce substance abuse/ chemical dependency

20%

Types of Goals

*Goals are not mutually exclusive across the 34 grantees.

Measuring Improvements in Mental Health Outcomes. Many (64%) of the grantees
successfully used measures to demonstrate improved mental health outcomes. For example,
one grantee used an agency developed tool, the Wellness Scale, to track client mental health
outcomes over time. On all dimensions of the Wellness Scale, clients exceeded an increase of
36% after 11 or more visits. The greatest increase was in the area of “Post Traumatic Stress”
(183% increase) followed by “Managing Thoughts and Feelings” (88% increase) and “Managing
Stress” (84% increase). At another grantee program, seventy-five percent of elderly clients
showed significant improvements in depressive symptoms as measured by a geriatric
depression scale within four months of in-home psychotherapy and case management
treatment.
Improving Living Skills and Social Competencies. More than half (56%) of the grantees
planning to improve their clients’ living skills and social competencies were successful in
achieving their goals. For example, at one grantee program, the majority of families who
accepted services reported strengthened parent/child relationships. Therapists developed and
nurtured a therapeutic relationship with the parent and child during therapy sessions, and this
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caring and nurturing relationship often continued between parent and child when the therapist
was not present. At another grantee program, parents who were reunited with their children
(after being under the care and protection of Child Protective Services) showed a 50% increase
in coping skills and a reduction in feelings of frustration and estrangement from their children
as measured by a pre- and post-test in parenting class.
Empowering Clients to Deal with Mental Health and Substance Abuse Issues. Increasing the
sense of empowerment to deal with mental health and substance abuse issues was another goal
grantees aimed to achieve with MHI funds. Of the seven grantees that planned to achieve this
goal, three (43%) were successful. For example, at one grantee site, clients participated in selfesteem and self-empowerment classes, self-defense and assertiveness trainings, anger
management and conflict resolution groups, family life classes, and health education and life
skills groups, all of which helped them to develop healthy relationship skills leading to the
development of strong support networks while in the program.
Enhancing Self-Esteem and Decreasing Depression. Grantees were also successful in
increasing their clients’ self-esteem (33%) and reducing depression and suicide rates (29%). For
example, one grantee reported that by the end of the program, approximately 80% of their
clients had higher levels of self-esteem and showed decreased levels of depression compared to
the beginning of the program. Another grantee reported that compared to intake, clients’
depressive episodes had decreased by 15% by program’s end.
Reducing Substance Abuse and Chemical Dependency. While the programs demonstrated
success in improving the overall mental health of their clients, positive outcomes related to
reducing substance abuse and chemical dependency were more difficult to achieve. Therefore,
addressing the substance abuse needs of the clients served by the MHI programs continues to
be an unmet need in many of the communities.
E. Improving Psychosocial Functioning and Behavior
More than three-quarters of the MHI grantees (n=36) planned to improve their clients’
psychosocial behaviors and overall functioning. Exhibit 17 presents the specific goals grantees
achieved related to improving the functioning of their clients.
Exhibit 17
Types of Goals for Improving Clients’ Psychosocial Behaviors and Overall Functioning

Types of Goals

General goals related to improving functioning
Decrease behavioral problems
Increase knowledge of prevention services and
community resources
Increase help-seeking behavior

Number of
Grantees
Planning to
Achieve
Goal
(Total = 36)*
5

Number of
Grantees Who
Achieved or
Exceeded Goal

Percent of
Grantees Who
Achieved or
Exceeded
Goal

60%

50%

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Number of
Grantees
Planning to
Achieve
Goal
(Total = 36)*

Number of
Grantees Who
Achieved or
Exceeded Goal

Percent of
Grantees Who
Achieved or
Exceeded
Goal

Increase treatment/medication compliance
Increase sense of health and well-being/increase
physical health outcomes/change in physical
demeanor or appearance

43%

40%

Increase healthy sexual behavior

33%

Increase housing stability
Increase healthy living skills/habits/educational
and communication skills
Increase family functioning, relationships, and
support
Increase attendance and performance at school/
Decreased school drop-out rates

33%

30%

27%

25%

17%

14%

13%

Types of Goals

Improve parenting skills
Decrease further incidents with Child Protective
Services (CPS)/decrease family violence and/or
child abuse
Improve client social support
networks/mentorship/relationship with peers and
the community
*Goals are not mutually exclusive across the 36 grantees.

Decreasing Behavioral Problems. Many of the MHI grantees were able to observe and
measure improvements in their clients’ functioning. For example, one grantee reported that at
the time of discharge, their foster children clients exhibited low levels of behavioral problems
and on average, scored within the normal range on the Child Behavior Checklist. The children
also showed significant improvements in somatic complaints, withdrawn behavior, sleep
problems, attention problems, and aggressive behavior. Compared to admission, children also
tended to be in more stable living arrangements at the time of discharge. Another grantee
reported that 70% of the children enrolled in their program showed improvement within a year.
Improvement was measured by whether or not the child reached standardized developmental
milestones as generally defined by experts in the field of child development. Children enrolled
in another program showed a 25% increase in social adjustment and a reduction in
destructive/disruptive behavior by program’s end. At another grantee program, an average of
77% of the clients over the course of the grant period sought out and accessed adjunctive
services and lower intensity support services on their own to maintain and improve functional
stability.
Increasing Knowledge of Mental Health Prevention Services and Community Resources.
Twelve grantees had planned to increase their clients’ knowledge of mental health prevention
services and community resources. Of the twelve grantees, half were successful in achieving
their goals. For example, one grantee provided linguistically appropriate mental health

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information in the form of brochures, leaflets and media articles to their Thai and Cambodian
target populations. Although stigma associated with accessing and receiving mental health
services existed in the communities, the outreach materials increased the target populations’
interest in mental health service and community resources. They became curious about the
availability of mental health services at the grantee organization and began calling the
organization to seek more information. Another grantee increased minority communities’
knowledge and use of available mental health services by educating 13,176 individuals on
suicide prevention during the three-year MHI funding period. Program attendees increased
their knowledge of suicide prevention services and community resources as evidenced by an
average increase of 21% on post-tests compared to pre-tests.
Improving Overall Family Dynamics. Many of the grantees planned to improve the
functioning of the family, including family parenting skills, and decreasing the incidence of
child abuse and Child Protective Services (CPS) involvement. Demonstrating successful
outcomes related to this goal was challenging for grantees given the complex and dynamic
nature of the family system. While many grantees demonstrated short-term progress toward
achieving this goal, sustainable changes within the family system were less prevalent over the
grant period.
F. Increasing Collaboration and Partnerships
An integral part of the success of the MHI-funded programs was the number of partnerships
created and maintained over the course of the three-year grant period. According to grantee
applications and progress reports, most grantees (n=38) planned to increase collaboration and
partnerships with other community-based organizations. Of the 38 grantees that planned to
achieve this outcome, 20 grantees (53%) reported that they either achieved or exceeded their
goal by the end of the Initiative. Exhibit 18 presents the specific goals grantees were able to
achieve related to increasing collaboration and partnerships with the community.
Exhibit 18
Types of Goals for Increasing Collaboration and Partnerships

Types of Goals

Establish advisory board and/or committee
Increase coordination of services among the
collaborative partners

Number of
Grantees
Planning to
Achieve
Goal
(Total = 38)*
22

Increase community ownership of program
Secure involvement of community stakeholders in
governance, treatment planning, program and
policy planning, and model development
Increase outreach to community-based
organizations

Number of
Grantees Who
Achieved or
Exceeded Goal

Percent of
Grantees Who
Achieved or
Exceeded
Goal

59%

33%

25%

21%

20%

*Goals are not mutually exclusive across the 38 grantees.

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Establishing Advisory Boards and Committees. Of those grantees that planned to increase
collaborations and partnerships with other organizations and agencies in the community, the
largest percentage of grantees (59%) were successful in establishing advisory boards and
committees. For example, one grantee increased the Latino representation on the County
Mental Health Advisory Board from zero to two Latino members. The grantee continued
recruiting local Latinos through the development of a program-specific Advisory Board.
Another grantee held monthly committee meetings with all its partners to develop, implement
and evaluate strategies that would help increase access to mental health services for its target
population. Although the collaboration began with tremendous friction among the partners, a
significant outcome of the project was the transformation of collaborative relationships that led
to the development and implementation of referral protocols for mental health services for the
target population among the partnering agencies.
Increasing Service Coordination Among Partners. Increasing coordination of services among
collaborative partners was another goal that 15 grantees planned to achieve. Of those grantees,
a third (n=5) successfully accomplished this goal. For example, one grantee had more than 20
collaborators that actively coordinated various program services and activities and shared
resources, such as referrals, speakers, educational programs, and transportation. At another
grantee program, improved coordination of services among the collaborative partners resulted
in a 17% increase in the number of adolescents referred for counseling services at the grantee
organization. Of these referrals, the majority were from the collaborative partners.
Increasing Community Program Participation and Ownership. Grantees were also successful
at increasing community ownership of programs and securing involvement of community
stakeholders in governance, treatment planning, program and policy planning, and model
development. For example, one grantee provided a mechanism for community feedback
through annual graduation ceremonies and other celebrations of achievement. The program
had an open door policy and was very involved in the community. Another grantee held 65
meetings with community stakeholders during the course of the project. A total of 851
community stakeholders attended these meetings, during which time the participants provided
feedback and input on the program.
Establishing Successful Partnerships
One of the unexpected outcomes of the MHI was the vast number of partnerships and
collaborative arrangements in which grantees participated to achieve the goals of their
programs. According to survey data, grantees established and maintained relationships with
397 partners during the course of the Initiative.
To gain a better understanding of the nature of grantees’ partnerships (i.e., the extent to which
partnerships were active or simply a formality), we asked grantees in the semi-annual surveys
to characterize their partnerships using the following scale: co-existence, communication,
cooperation, coordination, and collaboration. Using this scale, 32 percent of grantees’
partnerships were characterized as a collaborative relationship, which is the most developed
form of partnership, while only 4 percent of grantees’ partnerships were characterized as a coexistence relationship, the least developed type of partnership (see Exhibit 19).

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Exhibit 19
Type of Partnerships Reported by Grantees
Number
of Partners

Percent of
Partnerships
(n=397)

Co-existence: the entities may know of each other, but have no history of
interaction and know little about each other’s composition or way of doing
business.

Communication: the entities know about each other, have some history of
interaction and know the basics of each other’s composition or way of doing
business.

22%

Cooperation: the entities have established protocols or practices that involve
ongoing exchange of information integrated into routine practice/business.

16%

Coordination: the entities have committed to sharing resources, e.g., funding,
staff, equipment, space, in order to accomplish shared goals, and have
implemented activities that depend upon these shared resources. However, the
entities are not changing their core businesses or sharing decision making
outside the area of coordination (e.g., coordinated efforts may be independent
of the mainstream businesses or may be spun off entirely, as in some joint
ventures).

103

26%

Collaboration: the entities have actively engaged in shared planning and
decision making that is taken seriously in the business decisions of each entity,
such that each entity is willing to change its practices to achieve a shared goal.

126

32%

Type of Partnership

There were many benefits associated with partnership arrangements. Partnerships were not
only critical for enabling programs to implement their programs by providing valuable
resources, but they also allowed grantees to achieve several outcomes that they would not have
been able to achieve otherwise. According to results from the fourth semi-annual survey,
partnerships allowed grantees (n=33) to:
•
•
•
•
•

fill service gaps in the community (85%);
increase continuity of mental health care (82%);
increase geographic access to services (73%);
overcome staffing shortages (33%); and
influence state and local policy (33%).

The relationships grantees developed with their partners during the course of the MHI did not
end with the end of the Initiative. According to survey results, 97% of grantees that responded
to the fourth and final semi-annual surveys (n=37) reported that their relationships with their
partners have continued beyond the MHI grant-funded period. For example, one grantee noted
that they continue to have meetings with their partners once a month to discuss strategies for
providing bilingual mental health services to the youth in the community. Another grantee
stated that their relationship with their partners has continued in the same capacity as during
the MHI. Despite the end of the Initiative, they continue to share resources, refer clients, and
participate in cross-trainings. Several grantees also mentioned that they are working with their
partners to identify joint funding opportunities.

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G. Increasing Education, Awareness and Knowledge of Behavioral Health and Cultural
Issues Among Providers, Families and CBOs
Almost three-quarters of grantees (n=34) planned to increase education, awareness and
knowledge of behavioral health and cultural issues among providers, families and CBOs. Of
these, 24 grantees (71%) reported they achieved or exceeded their goal by the Initiative’s end.
Exhibit 20 presents the specific goals grantees achieved related to increasing the education,
awareness and knowledge of behavioral health and cultural issues among providers, families
and CBOs.
Exhibit 20
Types of Goals for Increasing Education, Awareness and Knowledge of Behavioral Health
and Cultural Issues Among Providers, Families and CBOs

Types of Goals

Number of
Grantees
Planning to
Achieve
Goal
(Total = 34)*

Number of
Grantees Who
Achieved or
Exceeded Goal

Percent of
Grantees Who
Achieved or
Exceeded
Goal

75%

67%

63%

60%

56%

53%

50%

Develop curriculum and provide training to CBOs
and local providers
Increase family understanding/knowledge of
mental illness and mental/medical health
Increase public understanding of multicultural
health, mental health and end-of-life issues
Increase exchange of knowledge among
providers/cross-training/foster professional
advancement
General goals related to increasing awareness and
knowledge of behavioral health and cultural issues
among providers and CBOs
Improve provider understanding of cultural and
linguistic competencies and appropriate service
delivery
Increase provider understanding of psychiatric
disorders and population-specific issues
*Goals are not mutually exclusive across the 34 grantees.

Training Community-Based Organizations and Providers. Of the 16 grantees that planned to
develop a curriculum and provide training to CBOs and local providers, three-quarters (n=12)
were successful in achieving their goals. For example, one grantee provided trainings to service
providers on the multiple variables that influence the behavioral, emotional and physiological
conditions of young children. The providers were also trained on working in an integrated
service model. Post-tests measuring course content knowledge indicated that the providers
successfully learned the material, with a mean accuracy of 75%. Another grantee provided
primary care providers and other staff at its health centers with trainings on the delivery of
behavioral health services. The providers and staff were trained on the management of medical

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illness with behavioral health problems and the symptoms and various treatment options for
post traumatic stress disorder and other behavioral health and chronic illnesses. For the
primary care staff at the health centers, a psychiatrist provided on-going in-service training.
Increasing Understanding and Knowledge of Mental Health among Families. Increasing
family understanding and knowledge of mental health was another goal that grantees were
successful in achieving (n=4). For example, clients at one grantee program showed statistically
significant improvements from pre- to post-test in their knowledge and skills related to
preventing family violence as measured from both the client’s perspective and the clinician’s
perspective. Clients noted improvements of 24% to 46% in dimensions regarding recognizing,
getting help and preventing abusive relationships, while clinicians noted improvements of 47%
to 67% in the same dimensions.
Increasing Public Understanding of Multicultural Health, Mental Health, and End of Life
Issues. Nineteen grantees planned to increase public understanding of multicultural health,
mental health and end-of-life issues through their program activities. Of these, 12 (63%) were
successful. For example, at one grantee program, 827 community residents participated in an
in-home education curriculum. According to pre- and post-tests, 95% of the participants
demonstrated an increase in knowledge about mental health problems, relaxation techniques,
mental health services, and various treatment and resource options. Another grantee
conducted a total of 391 outreach activities over the two-year duration of the project, increasing
the public’s awareness and understanding of the mental health needs, including end-of-life
issues, of Asian Pacific Islander older adults.
Increasing Opportunities for Knowledge Exchange and Professional Development Among
Providers. Another goal related to increasing education, awareness and knowledge of
behavioral health and cultural issues that grantees were successful in achieving was increasing
the exchange of knowledge among providers and fostering professional advancement. For
example, one grantee created an interdisciplinary setting for cross-fertilization of ideas
regarding infant mental health for professionals from different fields such as pediatric
medicine, nursing, nutrition, education, and family services. The professionals were trained in
the same overarching theory base and could communicate in a “common language,” thereby
reducing some of the barriers separating various systems. The major impact of this training
was the development of well-informed staff across systems with an ability to cross-refer,
exchange ideas and form integrated links.
H. Improving the Effectiveness of the Health System
Over half of the MHI grantees (n=24) planned to improve the effectiveness of the overall health
system in their communities. Of the 24 grantees targeting this outcome, 10 (42%) reported
achieving or exceeding this goal. Exhibit 21 presents the specific goals grantees were able to
achieve related to improving the effectiveness of the health system.
Exhibit 21
Types of Goals for Improving the Effectiveness of the Health System
Types of Goals

Number of
Grantees

Number of
Grantees Who

Percent of
Grantees Who

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Planning to
Achieve Goal
(Total = 24)*

Achieved or
Exceeded
Goal

67%

33%

Reduce incidence of arrests

29%

Increase appropriate referrals
Decrease the number of mentally ill clients
inappropriately placed in jails

25%

Reduce inappropriate inpatient psychiatric
admissions
Reduce inappropriate emergency room utilization
Increase integration of medical and mental health
structure/system

*Goals are not mutually exclusive across the 24 grantees.

In terms of improving the effectiveness of the health system, most grantees were successful in
reducing inappropriate inpatient psychiatric admissions (67%). One grantee observed a 65%
decrease in the number of hospitalizations among its clients from the initiation of treatment and
following one year later. Another grantee reported that the percentage of youth enrolled in the
program who indicated they had been hospitalized for psychiatric reasons decreased by 84%
from intake to discharge from the program.
Three grantees planned to reduce inappropriate emergency room utilization. Of these three
grantees, one achieved the goal. They reported a 25% decrease in acute emergency room visits
among their clients from intake to discharge from the program.
V. INITIATIVE ACCOMPLISHMENTS
This section of the report describes grantees’ accomplishments in achieving Initiative goals and
outcomes, including the development of leaders in the area of mental health; taking action to
influence and address policy concerns; and the achievement of sustainability. Findings
presented in this section are derived primarily from the semi-annual surveys.
A. Development of Community Mental Health Leaders
A notable accomplishment of the MHI was the development of mental health leaders in the
community. According to survey data, 40 out of 45 grantees (89%) reported that people from
the community or staff took on new roles of influence or leadership in the area of mental health
as a result of their MHI program. For example, two families at one grantee organization
stepped forward as liaisons within the greater community and were instrumental in
disseminating information about program services, volunteering, encouraging others to
volunteer at program events, gathering information and advocating for the needs of the
community at-large. Across the 40 grantees, a total of 356 individual leaders emerged. Of these
individuals, 41% were new leaders (with no prior leadership experience on mental health issues
or advocacy), 64% came from within the mental health profession, and 62% were Latino.
Increased Public Awareness of Mental Health. The leadership efforts of these new mental
health leaders impacted not only the program, but also the larger community. As Exhibit 22
shows, more than three-quarters of the grantees that reported the emergence of leaders in their
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communities stated that these new leaders were instrumental in increasing public awareness of
mental health and in increasing the reputation of the grantee organization. For example, the
Executive Director of one grantee organization helped to increase public awareness of mental
health by becoming involved in the Healthy Kids Initiative for Santa Cruz County. She chaired
the Initiative, which provided a comprehensive healthcare plan for uninsured children 0-18
years of age. Mental health was included in the plan based on the findings from the grantee’s
MHI-funded program.
Leadership Increases Organization’s Reputation. The leadership efforts of mental health
leaders at another grantee program increased the reputation of the grantee organization. Staff
at the grantee agency participated in mental health consultation groups and spoke at various
workshops and seminars about mental health issues. After three years, the staff became known
in the community as mental health leaders, and the grantee organization was seen as a
respected, quality-driven resource for the mental health needs of the poor and underserved in
the community.
Increase Public Knowledge of Mental Health. More than 70% of grantees also reported that
their new community leaders increased pubic knowledge of mental health. For example, the
consistent presence of one grantee organizations’ leaders at community meetings, leadership
committees, and cross-referral groups increased the public’s knowledge of the mental health
needs of the agency’s target population of transitional youth and how to effectively work with
that population.
Exhibit 22
Impact of Leadership Efforts
Type of Impact
Increased public awareness of mental health

Percent of Grantees
(n=40)
78%

Increased reputation of the organization the leader represents

76%

Increased public knowledge of mental health

73%

Decreased stigma associated with accessing and receiving mental health services

64%

Advocated for changes to existing mental health system and policies

58%

B. Influence on Local Policy
Most of the MHI grantees did not initially plan to influence local policy. However, over the
course of the three-year funding period, many realized that to affect change, they needed to
take matters into their own hands. According to survey data, 82 percent of the MHI grantees
reported that during the course of the MHI, their programs had taken specific action to address
policy concerns including supporting initiatives, mobilizing community organizations,
advocating for increased funding, and lobbying for efforts to improve the quality of mental
health care provided in California. For example, to address the lack of bilingual and bicultural

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mental health professionals in California, one grantee participated in the region’s Latino Mental
Health Collaborative to promote more programs that encourage and support Latino students to
become psychologists and psychiatrists.
More than three-quarters (77%) of the grantees (n=44) attempted to inform policy makers or
decision makers of findings, information, and results their MHI-funded programs had
generated. Grantees accomplished this through a variety of ways, including presenting at
forums targeting policy makers and decision makers (56%); calling legislators and policy
makers (43%); requesting information on legislation to better position the program to be eligible
for funding (36%); and writing letters to legislators and policy makers (34%). For example, the
CEO of one grantee organization actively participated in the Community Clinics Association of
Los Angeles County to advocate for the Asian and Pacific Islander communities and their need
for mental health services. Her efforts and those of other community-based organizations
placed pressure on legislators and community leaders to increase mental health access for
indigent populations. At another grantee program, staff called legislators and policy makers to
protest state and local budget cuts for the Regional Centers and CalWorks Stage III. Staff at a
third grantee organization were involved in promoting the Mental Health Ballot Initiative by
gathering petition signatures and increasing awareness of the ballot initiative in the public.
In addition, about two-thirds (67%) of the grantees reported that program staff served on local
boards and committees that made decisions about the local mental health system. For example,
one of the co-directors of a MHI-funded grantee program was the Director of the Community
Behavioral Health System of the Department of Public Health, the decision maker for the local
mental health system. Another grantee reported that its Executive Director was a very active
member and former president of the Board of ACHSA (Association of Community Human
Service Agencies), which consisted of mental health agencies in LA County that discussed and
made decisions regarding policy and advocacy issues.
C. Achievement of Sustainability
As with any funded initiative, funding for several grantee programs ended with the grant. In an
effort to sustain their programs beyond the MHI funding period, grantees (n=43) developed
written sustainability plans (58%) and secured financing or reimbursement for services rendered
(67%).
Exhibit 23 presents a break-out of the extent to which and how grantees sustained their
programs beyond the MHI funding period. As the Exhibit shows, almost half of grantees (48%)
sustained components of their programs, while 20 grantees (43%) sustained their entire
programs. The remaining seven grantees had either their entire (n=2) or components (n=5) of
their programs institutionalized/adopted by another organization or the parent organization.
Exhibit 23
Distribution of Grantees by Nature of Program Sustainability

Nature of Planned Program Sustainability
Whole program will be sustained

Number of
Grantees
(Total = 46)*
20

Percent of
Grantees
43%

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Components of the program will be sustained
Whole program will be institutionalized11/ adopted by another
organization or parent organization
Components of the program will be institutionalized/ adopted
by another organization or parent organization

48%

11%

*Levels of sustainability are not mutually exclusive across the 46 grantees.

Funding Sources
Throughout the course of the Initiative, grantees applied for a number of program-specific
funds to help sustain their MHI programs. Of the 46 MHI grantees, thirty-six (78%) applied to
189 different funding sources for a total funding amount of $48,526,453 . Of these requests, 31
grantees were able to secure funding from 108 different sources for a total of $37,408,492.
Exhibit 24 presents the types of funding sources (i.e., federal, state, foundations, other) for
which grantees applied and received.
Exhibit 24
Distribution of Funding Sources Applied to and Received by Grantees
Funding
Source

Number of
Different
Grants/
Contracts
Applied To

Number of
Different
Grants/
Contracts
Received

Number of
Grantees
Applying
(n=36)*

Number of
Grantees
Receiving
(n=31)*

Total
Funding
Applied

Total
Funding
Received

Federal

$27,695,035

$22,035,035

State

$6,294,706

$4,364,045

Foundations

$4,517,300

$1,125,000

Other

$10,019,412

$9,884,412

TOTAL

189

108

$48,526,453

$37,408,492

* Funding sources applied and received are not mutually exclusive across the 36 and 31 grantees,
respectively.

In general, grantees experienced success in their efforts to sustain MHI initiated programs in
whole or in part through securing program-specific funds. The 21 grantees that applied for
federal funding sources achieved an 80 percent success rate, securing over $22 million, which is
impressive given that federal funding opportunities tend to be extremely competitive. The
success rate for obtaining funding from state and other sources was also impressive at 69
percent and 99 percent, respectively.

Institutionalization refers to the extent to which the program/project/intervention has been integrated into the
culture of the organization including normal business operations of the sponsor/partner institutions(s) or the
formation of a new entity to recognize the value of the intervention and sustain effect of outcomes.

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Federal sources from which grantees received funding included: SAMHSA/Center for Mental
Health Services (CMHS), SAMHSA/Center for Substance Abuse Treatment (CSAT), the Health
Resources and Services Administration (HRSA), the Department of Housing and Urban
Development, the Indian Health Service and the State Department. State funding sources
included Medi-Cal, CalWorks, Victims of Crime, Prop 10, Department of Mental Health and the
Department of Child and Family Services. Foundation sources included: St. Johns Health
Foundation, Oserfund, San Francisco Foundation, Hospice Foundation of the Central Coast, The
Ahmanson Foundation, Nick Traina Foundation and the Hispanic Foundation. Grantees also
received funding from other sources including Shasta First 5, Hawthorne Elementary School,
Tobacco Settlement Advisory Committee, County of Los Angeles, City of Santa Monica,
Philanthropy Funds - Clinic Board, and the Community of Mental Health.
VI. UNANTICIPATED OUTCOMES
In addition to the planned outcomes the MHI grantees achieved during the course of the
Initiative, they also experienced a range of unanticipated outcomes and influences, both
positive and negative. It is not surprising that grantees’ program activities had an immediate
and far-reaching impact or ripple effect on their larger organizations, across systems (e.g.,
education, human services, criminal justice), and within communities. Some of the more
common unanticipated outcomes experienced by multiple grantees included the provision of
wrap-around care; the effectiveness of informal, non-traditional mental health services; the
greater than expected need for services; the absence of mental health providers in the
community; the dissemination of program findings; increased knowledge of and respect for
grantee organizations; evaluation challenges; and fiscal constraints.
Provision of Wrap-Around Care: Many grantees did not anticipate that their clients would
present with a multitude of stressors that would affect their mental health and well-being (e.g.,
lack of housing, no income). Grantees quickly realized that in order to address their clients’
mental health needs, they had to also address their other physical, social, and economic needs.
To address clients’ multiple needs, grantees established partnerships with other communitybased organizations, leveraged agency resources and devoted program time for various client
needs such as transportation, translation services, and accompaniment to public agencies for
housing and Social Security benefits. Although unexpected, the MHI grantees addressed the
diverse and complex needs of their target populations by providing wrap-around care with a
holistic approach, which helped their clients to manage their mental health concerns and to lead
healthy and productive lives.
Delivery of Informal, Non-traditional Mental Health Services: As grantees implemented their
programs, they realized that many of their clients were not responding well to formal,
traditional mental health services and interventions. Many clients were reluctant to openly
discuss their mental health problems with complete strangers. In response to client feedback
and input, many grantees began offering more informal, non-traditional mental health services.
For example, several grantees that had originally planned to provide individual counseling
services ended up offering group therapy, artwork classes, physical education, and other
recreational activities.

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Need for Intensive Services: Grantees underestimated the level of mental health needs within
their communities. Many clients who came through the door presented with problems that
required significantly greater resources than grantees’ had anticipated. Once community
members were aware of the services available at the grantee organization, grantees often
experienced a “woodwork effect”, resulting in larger than expected caseloads. Although
grantees knew they would be filling gaps in mental health service delivery, they were surprised
by the number of separate encounters with individuals and the amount of time clients spent
with mental health professionals, illustrating the high demand for such services.
Sole Provider in the Community: Although many grantees realized that they would be
providing much-needed services to underserved populations in their communities, they did not
expect to be the sole provider of mental health services in their community. Without the MHIfunded program, the needs of many communities throughout California would not have been
addressed. Grantees provided valuable and much-needed services to several different target
populations, most of whom were underserved.
Dissemination of Program Findings: Though unexpected, many grantees were invited to
share their program model and outcomes at various local, state, and national conferences and
meetings. These dissemination activities helped grantees to build their own capacity to share
the impact of their programs and encouraged them to quantify their program findings through
detailed evaluations.
Increased Knowledge of and Respect for Organization: As a result of MHI-funded program
activities, many grantee organizations became known and respected agencies in their respective
communities. Some organizations became community resources for questions and concerns
related to mental health, while others became a popular place for students interested in mental
health and mental health interns to apply for jobs. This acknowledgment as a respected
organization also led to improved relationships with County Mental Health and other
community agencies.
Evaluation Challenges: An unanticipated challenge for many grantees was the difficulty of
evaluating the effectiveness of their programs. Grantees did not anticipate that evaluation tools
would have to be translated and that implementing evaluation plans would take considerable
time and resources away from the regular duties of the program staff. Data collection also
proved to be challenging as many grantees worked with transient target populations who were
often unavailable for follow-up. As a result, grantees experienced challenges implementing
consistent follow-up procedures. Many grantees were able to collect baseline data, but did not
have reliable follow-up data with which to compare.
Fiscal Constraints: Another unanticipated challenge that affected grantees throughout the
course of the Initiative was the financial state of California and the competing fiscal priorities of
both the local and state governments. The budget shortfall at both the county and state level
resulted in significant reductions in reimbursable services through state and local programs.
The reduction of services placed the provision of mental health services at the bottom of the
priority list. Grantees reported that the city and state budget cuts impacted the availability of
mental health services provided through the county. When a grantee identified the need for
more intensive services or referrals to public agencies, there was no place to send their clients.
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In addition, cutbacks at the federal, state and local level resulted in many Californians without
insurance and with greater medical and mental health needs and fewer resources to meet those
needs. With careful and strategic planning, the recent passing of Proposition 63 may mitigate
some of the service provision gaps left in the mental health system as result of economic
downturn.
VII. PROMISING PRACTICES/LESSONS LEARNED: THE GRANTEES PERSPECTIVE
Through their program efforts during the three-year funding period, the MHI grantees
identified successful or promising practices that were deemed to be effective based on anecdotal
feedback or experiential instinct. Grantees identified promising practices in the areas of 1)
program planning and implementation; 2) staffing; 3) client engagement; 4) service delivery; 5)
collaboration/partnership development; and 6) program evaluation. Exhibit 25 highlights
promising practices and lessons learned identified by grantees across these six areas.
Exhibit 25
Overview of MHI Promising Practices/Lesson Learned
•
•
•

•

•
•

•

•
•
•
•
•

•

Program Planning and Implementation
Allow ample time for strategic planning, for the training of staff, and for formalizing cross-agency
partnerships.
Learn about the communities with whom you are working before attempting to provide services.
Include the target population in all stages of planning and implementation; it helps to create a
tremendous sense of loyalty and commitment to the program, as well as keep the program in-line
with the actual needs and expectations of the intended participants.
Be flexible and prepared to change original plans in response to client and community needs.
Changes should be viewed as opportunities, not setbacks, to meeting previously unidentified needs
in the community.
Build in time and cost for technical support (hardware, software, data entry, clerical support) and
staff time for thoughtful program monitoring and evaluation.
Staffing
Realistically determine staffing needs and costs associated with recruiting and hiring staff.
Be realistic with the local labor market. There is a dearth of licensed, experienced, and bilingual
mental health professionals. Consider “growing your own staff” by hiring staff who do not have the
academic training and/or experience, but who have the interest and enthusiasm to perform the work,
and then support and bolster them with clinical supervision once they are hired.
Although it is ideal to have staff who are bilingual and bicultural, using a translator is a viable
alternative.
Client Engagement
Eliminate “mental health” from the name of the program.
Do not use the terms “counselor” or “psychologist” when referring to mental health professionals.
Use incentives to attract clients to the program (e.g., food, childcare, celebration events).
“Meet the community where it is at” by locating services in locations that are familiar and
comfortable to the clients.
Consider using lay mental health workers, rather than licensed mental health providers, to leverage
their stronger connection to the community; the value of the culture-to-culture connection is more
important than someone who is trained in mental health.
Approach the community about its immediate needs (e.g., housing, childcare, transportation) before
focusing on mental health needs.
Service Delivery

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•
•
•
•
•
•
•

•

•
•
•
•
•

•

•
•

•

To address problems of a complex and high-needs population, incorporate a multi-systemic, multimodal approach.
Provide the full range of services needed by the population (e.g., housing, medical care, benefits), or
make referrals to those services.
Recognize that each individual client is unique and has different needs; what works for one person
may not work for another.
“Go to where the client feels at home,” and do not disrupt family routines when delivering services.
Include family members in the client’s treatment. Client progress is strongly linked with their home
and community environments.
Listen to client and staff feedback, and modify program services accordingly.
Integrate mental health services into other services such as case management, provide ancillary
services in a single location, and co-locate services with partnering agencies.
Collaboration/Partnership Development
Work in collaboration with other programs internally, as well as community collaborators and
partners. Partners can help disseminate information about the program, solicit referrals, and gather
resources that clients might need.
Spend time before program implementation with all partner and team members to learn to work
together and to understand and respect each other’s views and philosophies. Partner and team
members can come from different work environments and have different missions and goals.
Clearly define roles and responsibilities of each partner agency in writing at the time the proposal is
submitted.
Develop lines of supervision, day-to-day direction, and clear decision-making models for
collaborative partners before program implementation.
Maintain frequent communication with collaborative agencies, especially at the beginning stages; this
helps to establish a better, more efficient relationship.
Work with partners to overcome unexpected challenges.
Establish a close relationship with collaborating agencies and community leaders to expand ideas and
build trust; remember that trust takes time, both within the collaborative and in the community.
Program Evaluation
Hire an experienced data analyst and someone familiar with outcome measures right at the
beginning. Quantifying mental health outcomes and developing the appropriate database can be
challenging. However, if obtained appropriately, outcome measure data can be used for marketing
other programs and leveraging additional grants.
Establish an evaluation component at the beginning of the program. Program evaluation is not just
about getting results; it’s about shaping the process. Information gleaned from program evaluation
in its earliest stages helps to inform program evolution.
Have a strong data collection plan that is clearly defined and consistent among collaborating
partners.
Ensure that there is a mechanism in place to retrieve needed data from partnering agencies,
particularly if retrieval of this data is key to reporting successful completion of project objectives.
Ideally, the scope and breadth of agreed upon data sharing, including deadlines for reporting data,
should be built into the scope of work for those agencies with subcontracts. For agencies without
subcontracts, specific language should be built into the MOUs.
Share evaluation data with staff and partner agencies so they know that their efforts with clients have
resulted in positive changes.

VIII. CONCLUSION
Overall, the MHI was a success. Based on grantees’ accomplishments, all of the Initiative’s
goals were achieved. More than 145,000 individuals were served during the three-year grant

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period. Many of these individuals would not have had access to mental health services if not for
the MHI. The MHI grantees also provided services that were non-stigmatizing and culturally
competent. Through their service delivery, grantees improved clients’ mental health and
functioning outcomes and helped clients to lead healthier, more productive lives. During the
course of the Initiative, the MHI grantees developed and maintained relationships with 397
community partners. Many of these relationships continued beyond the MHI-funding period. At
the community and system level, the grantees helped to increase education, awareness, and
knowledge of behavioral health and cultural issues among providers, families, and CBOs;
improved the effectiveness of the health system; developed 356 community mental health leaders;
and influenced local policy. By the end of the three-year funding period, all 46 grantees had
sustained either their entire program or components of their program.

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File Type	application/pdf
File Title	Microsoft Word - Appendices_Bright Futures_NEW.DOC
Author	acash
File Modified	2009-07-21
File Created	2009-07-21