Person and Family-Centered Approaches in Mental Health and Co-occurring Disorders Online Training Lesson #3: Cultural Responsiveness

wordmarks: Institute on Community Integration, Research and Training Center on Community Living, and University of Minnesota

Welcome to the Minnesota Department of Human Services Online Training Program in Person and Family-Centered Approaches in Mental Health and Co-Occurring Disorders

Training Program Description: This training program is designed for professionals in the mental and chemical health community. It may also be useful to others with interested in supporting people with mental health conditions to live well. This training program supports learners in understanding the value in trends toward person and family-centered approaches in Minnesota. It provides context to this movement that is Minnesota specific and helps learners support the vision the Minnesota Olmstead Plan. The content provides both context and enhanced skills in these approaches and practices.

Directions: Please scroll down or click on the page on the menu to see additional content in the lesson.

The following lessons are included in this training program:

  1. Lesson #1: The Context of Person and Family-Centered Practices in Mental Health Services in Minnesota
  2. Lesson #2: The Journey to a New Vision
  3. Lesson #3: Cultural Responsiveness
  4. Lesson #4: Support for Relationships and Valued Social Roles
  5. Lesson #5: Supporting People with Mandated Services and Choice Limits
  6. Lesson #6: Individual Practices that Support Person and Family-Centered Approaches
  7. Lesson #7: Organizational Practices that Support Person and Family-Centered Approaches
  8. Lesson #8: Engaging in System and Community Level Changes

A Note about Language: This training program recognizes that the terms mental health professional and mental health practitioner are recognized titles have specific meaning related to scope of practice within the Minnesota mental health system. However, for the purposes of this training, the terms practitioner or professional are used interchangeably to indicate any person with professional responsibilities in the system. This includes clinical professionals such as psychiatrists. It also includes social services professionals such as case managers or peer specialists. If a specific role or scope of practice is important to content, that is made clear in content.

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“All must be represented and have a voice!”
- Co-creation Participant, Minneapolis MN

“It [human service systems for mental health] is working, but it’s not working for everybody. That’s the concern I have.”
- Co-Creation Participant, Duluth MN.

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A photo representing a Minnesota Specific American Indian community.

Welcome!

Here is a description of the lesson you are starting:

An essential part of being person and family-centered is the ability to work with people in the context of their culture, worldviews, and experiences. To do so requires self-awareness and humility on the part of professionals. It requires awareness of broader issues related to equity. This includes intersectionality, historical traumas, cultural differences, and current realities of individuals. This lesson is meant to help professionals think more deeply about how they approach equity and diversity in services and supports. It is meant to help them consider and develop their skill in delivering more culturally responsive services and supports.

Learning Objective

After completing this lesson, you will be able:

  • Develop a plan for enhancing skills and approaches in the area of multi-cultural responsiveness and equity.

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A section of city where windows are boarded up.

All people do not equally benefit from Minnesota’s investments in health and wellbeing.

Minnesota Context

Multiple reports that focus on quality of life, health and wellness in Minnesota point to strong inequities. Minnesota ranks as one of the best states in the county in these areas as a whole. However, the state is among the worst in key areas for people of color. This includes American Indians and African Americans. It includes immigrant populations from Asia, African, and Central or South America. Minnesota also struggles with inequities in access for people with disabilities, rural Minnesotans, and others such as veterans or members of LGBTQIA community. These inequities in Minnesota are historic and deeply embedded. They run across all the systems of the state. Some of these include the public school system, the criminal justice systems, the transportation system, and of course health and human service systems.

It is impossible to be person and family-centered if these issues are not acknowledged. They must be worked on in strategic and systemic ways. This lesson is meant to support individual practitioners in improving their ability to work directly with people in person and family-centered ways that are culturally responsive. However, inequities are about many things. Systemic attention to the social determinants of health are needed to make strong change in these inequities. Therefore content also supports understanding of these larger issues.

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Terms and Concepts to Frame Cultural Responsiveness

There were a number of issues, concerns, and important messages that came across in discussing cultural differences and inequities. This training curriculum was built with these discussions and issues in mind.

Directions: Click each item to learn more.

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Person at synagogue with family.

An opportunity to be part of things that matter to you is essential to person and family-centered practices.

Developing a Skilled Approach

To be person and family-centered you must be able to recognize unique cultural contexts. You must be able to incorporate these into plans and approaches. Many practitioners can struggle with doing this well. They often have good intentions. However, this requires a deeper commitment. To develop a skilled approach training and self-development specifically in this area are very important.

The next several screens provide examples of common pitfalls in these areas. As you go through these, consider your own practice and how these might apply. Also consider larger issues. This may include policies and practices of your organization. This can include funding and gaps in services. It can include the intersection of other social issues such as poverty or criminal justice practices in communities. Jot notes as you go about how things that you notice or wonder about. You can use these to write out a development and action plan in these areas when prompted at the end of the lesson.

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Pitfall: Assuming Cultural Responsiveness is a Training Issue

It is common to believe that all organizational or system problems can be solved by training. However, many other aspects effect this.

Directions: Click each item to learn more.

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Pitfall: Not Being Aware of Embedded Cultural Views

The majority of culture and worldview are invisible, unspoken, and assumed. We tend to only notice “culture” when it is not our own.

Directions: Click each item to learn more.

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Pitfall: Not Recognizing that Culture Influences Behavior

People tend to think of cultural as the most superficial aspects. They think about how people dress or what they eat. The think of type of spiritual practices or customs they have. When faced with behavior they don’t understand, they rarely understand when cultural differences are part of the issue.

Directions: Click each item to learn more.

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Pitfall: Assuming People Can or Should Express Cultural Needs

People may or may not be interested in sharing their cultural views with professionals. Even if they are interested, they may not be able to.

Directions: Click each item to learn more.

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Pitfall: Not Recognizing Strengths and Resiliencies

In general, mental and chemical health treatments and services focus on deficits rather than strengths. However, people usually succeed in life by building on their strengths. Person and family-centered approaches specifically ask us to look for strengths. However, when there are cultural difference, the professional may struggle more to identify and build on strengths.

Directions: Click each item to learn more.

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Pitfall: Using Information to Stereotype

Learning about other cultures should be a respectful process. It is meant to help you have a broader understanding of different ways that people think or believe. It should help you be more flexible and curious in your approach. Whatever you learn about cultural groups should only expand your creativity not limit it.

Directions: Click each item to learn more.

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Creating a Development and Action Plan

Everyone is on a continuum of learning when it comes to cultural responsiveness. Take a minute to consider your next steps in developing yourself and your organization in this area.

Directions: Click on each tab to reflect on further learning and action you would like to take in this area. Write out your responses.

Conclusion and Review

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Conclusion

This lesson was meant to help you achieve the following learning objective:

  • Develop a plan for enhancing skills and approaches in the area of multi-cultural responsiveness and equity.

Lesson Review

In this lesson you learned:

  • Minnesota invests in health and wellness. However, inequities based on race and heritage are some of the worse in the county.
  • There are many ways to frame cultural responsiveness. What is important to looking beyond just training of individuals to systemic issues. This include polices, funding, and seeking leadership from communities affected.
  • There are a number of common pitfalls that service organizations or mental and chemical health professionals can face when working with people from underserved populations.
  • It’s important for individual professionals and organization to continually reflect on the influence of culture in services. This includes, recognizing the cultures they come from. It includes learning more about other cultural views.

Reviewed Trainings and Resources as Part of the Person and Family-Centered Approaches in Mental Health and Co-Occurring Disorders Training Development Project

Introduction to this Resource List

This list was developed as part of a training project to help mental health professionals, practitioners, and others in the mental health community in Minnesota enhance their ability to deliver services in person and family-centered ways. The project included identifying what training and resources were already available in Minnesota and how well they might meet the needs of the mental health and behavioral health community. There was a special focus on those in Targeted Case Management roles. A standard protocol that included a review tool and at least two reviewers was used to ensure products were reviewed consistently. The following materials were reviewed and ranked as being likely to be helpful to Mental Health Targeted Case Managers or those in similar or related roles.

Materials Developed by The Learning Community on Person-Centered Practices

The Learning Community on Person-Centered Practices

TLCPCP is an organization and a global volunteer community. It focuses on supporting people who have lost or may lose positive control because of society's response to the presence of a disability or other conditions. It does so through training and development of person-centered practices. The Minnesota Department of Human Services Disability Services Division and other divisions have invested in disseminating training materials developed by TLCPCP. They have also supported development of trainers in Minnesota. The following two trainings are commonly available in the state. TLCPCP also supports other types of training. To locate trainings in Minnesota you can go to http://pct.umn.edu. Certified trainers are also listed on The Learning Community’s website. Some local trainings listed at the Minnesota site are free; others have a fee.

Person-Centered Thinking- Two Day Training (now modularized)

Person-Centered Thinking is equivalent to a full two-day training. Training is completed in groups. The terminology and strategies of this training are aligned with some state and national regulations in the area of person-centered practices. The curriculum is generic and skills are transferable to any setting including mental health settings. A wide variety of professionals could benefit from this training. This can include professionals from any scope of practice who:

  • Are brand new to these skills and concepts.
  • Want to understand these skills and concepts in a broader context than individual practice.
  • Want to revisit these skills or expand their repertoire of strategies and approaches.
  • Want to network with others in and out of their agency around these practices.

The concepts and strategies in this curriculum have meaning and are useful in mental health practices. However, the examples in the core curriculum focus mostly on adults, are not all mental health related, nor always current to the context of community living. Content does not explicitly support deeper understanding of equity or diversity issues and does not use examples that represent diversity. Though there is a small portion in the new version on culture, on the whole, the curriculum does not attend to these issues. In addition, there is no specific tie in to how to use these practices to ensure family-centered practices. Trainers in this curriculum have various backgrounds. It would be important to select a training with a strong background in mental health services and supports if that is an important training need for your group.

Picture of a Life Two-Day Training

Picture of a Life is two-day training that provides in-person learning and applying person centered thinking and planning tools to develop a person-centered description. The process is focused on helping a person envision the life they want in their community. The training include a co-trainer with support needs and others who are this person’s natural or paid supporters. Trainees get a chance to watch and participate in interviewing processes and enhance their discovery skills. Values of choice, control, direction, and shared power are modeled in the training.

The quality of the training is highly dependent on the skill and knowledge of the facilitator and the willingness of the co-training and supporters to share. Participants will likely benefit more if they attend a session where the co-trainers needs are similar to those of the populations they support. There will be no explicit connection to the mental health practices of recovery, peer support, or cultural and equity practices if the facilitator does not have these skills, knowledge, and orientations. Person-Centered Thinking (described above) is required training before attending Picture of a Life.

Person-Centered Counseling Training Program

The Person-Centered Counseling Training Program is a blended learning model that embeds the Person-Centered Thinking skills and planning skills into online modules. The target audience for this training is counselors through the Aging and Disability Resource Centers (ADRCs) and others who are engaging in development of No Wrong Door systems. The online component is available in Minnesota via DirectCourse. For full review for this audience please see description below. For more information on the in-person day of training, contact The Learning Community for Person Centered Practices.

Materials Available Through the DirectCourse

DirectCourse is a national online curriculum for direct support professionals and similar professionals who support people to live in their communities. It is available in Minnesota through support from the Department of Human Services. The training programs and curriculum are self-paced, competency-based, and multimedia. The following materials from DirectCourse were reviewed for the mental health community.

College of Recovery and Community Inclusion (CRCI)

This online training was developed by Temple University Collaborative on Community Inclusion of Individuals with Psychiatric Disabilities. It consists of approximately 38 hours of self-paced training for community based mental health workers. The set of available courses is listed below.

  • Understanding Community Inclusion
  • Cultural Competence in Mental Health Service Settings
  • Introduction to Mental Health Recovery and Wellness
  • Mental Health Treatments, Services and Supports
  • The Effective Use of Documentation
  • Universal precautions and Infection Control
  • Seeing the Person First: Understanding Mental Health Conditions
  • Professionalism and the Community Mental Health Practitioner
  • Understanding the Health Insurance Portability and Accountability Act (HIPAA)
  • Understanding Trauma and Its Impact

The courses in the College of Recovery and Community Inclusion can be helpful to any practitioners interested in recovery-based inclusion and self-determination models. The suite of courses in CRCI doesn’t use term “person-centered” but aligns with these approaches. They cover the scope of all mental health professionals. This material can be useful to support planners in mental health in apply the Minnesota Olmstead Plan expectations in their work. These courses consider culture and evidence-based practices. Incorporation of family into support is not included substantially.

The Minnesota Department of Human Services has purchased a limited amount of seats in Minnesota that are available for free. Contact Nancy McCulloh at mccul037@umn.edu. Rates for broader access will vary based on organization size. Information can be obtained by contacting Bill Waibel at Elsevier, b.waibel@elsevier.com.

Person-Centered Counseling (PCC) Training Program

These online materials were explicitly designed for the No Wrong Door System of Long Term Services and Supports (LTSS). It considers all populations, all ages, and all methods of payment for LTSS. Person-Centered Thinking and Planning skills are a core of the training program. There is a whole course on family caregiving and other lessons on family involvement. However, content is not strictly focused on mental health.

This content would be best for disability generalists who have a portion of their potential recipients living with serious mental illnesses. Another potential target audience is staff affiliated with Certified Community Behavioral Health Clinics or Behavioral Health Homes or similar services, where clinicians and LTSS and community professionals need to have a coordinated understanding of person-centered practices across clinical and community settings. This curriculum needs to include a one-day in-person training in PCT to be considered complete as far as PCT skills. It would need a skilled training to support groups in organizing a blended learning model for above purposes. It is not ideal as core training for MH TCM because of the more broad disability focus but is rooted in recovery principles, self-determination, and culturally responsive services.

The Minnesota Department of Human Services has purchased a full contract for this curriculum in Minnesota that makes training available for free and/or with minimal administrative costs. Go to: https://mn.gov/dhs/partners-and-providers/training-conferences/directcourse/to learn more.

Materials through the Yale Program for Recovery and Community Health

The Yale Program for Recovery and Health, Person Centered Approaches has a focus on research, consultation and tools in the area of person-centered approaches in mental health and co-occurring disorders.

The following resources related to authors and researchers at this program were reviewed.

Partnering for Recovery in Mental Health: a Practical Guide to Person-Centered Planning

Partnering for Recovery in Mental Health is a practical guide for conducting person and family-centered recovery planning with individuals with serious mental illnesses and their families. This guide represents a new clinical approach to the planning and delivery of mental health care. It emerges from the mental health recovery movement, and has been developed in the process of the efforts to transform systems of care at the local, regional, and national levels to a recovery orientation.

This is a very solid and recommended resource that looks comprehensively at person and family-centered practices in planning specific to mental health conditions and co-occurring conditions. It provides context to recovery, self-determination, cultural needs, family support, and shared power. It is a good overall resource that would be helpful to any professional working with people with serious mental illnesses and required to complete support or treatment plans, including targeted case managers.

This book is authored by Janis Tondora, Rebecca Miller, Mike Slade and Larry Davidson and was published in 2014 by Wiley-Blackwell. It is available online as an ebook or from booksellers in hard copy, for an approximate cost of $42.00.

Getting in the Driver’s Seat of Your Treatment: Preparing for Your Plan

This resource is a downloadable booklet for organizing information a person might want in a treatment or support plan. It is meant to help people organize their thoughts and information in ways that are likely to yield person-centered goals and approaches in a treatment plan.

The strengths of this resource include: It is easily downloadable from a public site. It is concrete, process-oriented, flexible and applicable to many circumstances, and written in plain language. It gives people structure and context to taking the time to identify their goals and preferences in key areas outlined in the Person-Centered Informed Choice Protocol (DHS, 01/17). It asks people to consider including people important to them in the process. It would be a great foundation for developing a person-centered plan. Professionals and practitioners for all level of practice in mental health would benefit from being familiar with this tool. Case managers, support planners, and those in similar roles would benefit the most. There is a Spanish language version available.

Limitations of this resource include: The rights information is specific to the state of Connecticut (but could be easily customized to Minnesota). It provides little context for bigger picture aspects of history and professional responsibly. While it may work with a variety of cultures and circumstances, it does not support practitioners in how to adapt for a variety of cultures and circumstance. Family and natural supporters are considered as support but not as people who may need support. Information would need more work to translate into an operational treatment plan. Literacy would be an issue with this tool if used without assistance.

Authors are Tondora, Miller, Guy and Lanteri. Published in 2009 by Yale Program for Recovery and Community Health.

This online resource is available as a .pdf document at no cost:

Materials Offered Through the Copeland Center for Wellness and Recovery

The Copeland Center for Wellness and Recovery promotes mental health recovery through education, training, and research based on WRAP©. (Wellness Recovery Action Plan). It is a peer run, non-profit organization that provides training, consultation, and program activities to support the wellness, recovery, community inclusion and peer support journeys of individuals. They work with the owners of WRAP© materials at Advocates for Human Potential (AHP) to ensure the fidelity and quality implementation of WRAP© Facilitation in the health care system. There are a variety of training and consultation options offered through Copeland.

Locally people can connect and take seminars through the Kaposia which is an International WRAP© Center for Excellence.

Seminar I: Developing Your Own WRAP©

The Developing Your Own WRAP© workshops is co-facilitated by WRAP© Facilitators in a variety of formats and agendas, including 8-12 week WRAP© groups, 2-3 day workshops, retreats. Participants in these workshops will learn how to develop their WRAP© as a personalized system to achieve their own wellness goals. These workshops are for anyone and can apply to any self-directed wellness goals. WRAP© is a safe, effective wellness process that has an evidence-base for supporting mental health recovery. It is s self-directed, peer supported process that the person engages with in ways that they prefer. WRAP© is an ongoing processes of reflecting on and engaging approaches and lifestyles that support personal wellness. Processes can be used by individuals and organizations to move to a true recovery and self-determination focus in services and supports. WRAP© has proven to be an effective approach to working with children, youth, and families and caregivers to improve relationships, feel more hopeful, create support systems, learn to self-advocate, and put a greater focus on their personal overall wellness.

WRAP© must be delivered with fidelity in order to meet the evidence based criteria. This include that participation in WRAP© be completely voluntary, that at least two peer facilators who are skilled, trained, and mentored facilitate this process, materials are appropriate, and all processes align with the values and ethics of WRAP©. (To learn more about fidelity download and read the document The Way WRAP Works!.) Professional who have their own WRAPs can benefit from the process and also understand the value and power of WRAP© in supporting recovery.

WRAP© is voluntary, focused on wellness, owned by the person, and avoids clinical or medical language. It is a powerful tool for helping people reconnect with hope, personal responsibility, and personal strategies for recovery. However, it is not something professionals can have access to without a person’s permission and it is not something professionals can require of people. If people chose to complete a WRAP© on their own, it can support their ability to more clearly define many of the aspects of the PCICTP. It is something to recommend, especially to people who have lost touch with what recovery and a life worth living means to them. However, there can be no expectation that people participate unwillingly or in order to receive services.

The cost for this entry course ranges from $100-400.00 approximately. Locally, there may be a possibility for a need-based reduction in the fee or waiving of the fee.

References

Credits

The content of materials developed through this contract was co-created with members of Minnesota’s communities. Co-creation include structured and open-ended conversations as well as listening sessions. It also included seven structure co-creation processes conducted in different parts of the state. These sessions include professionals and people with lived experience or their families. Community members were also invited to review and edit the content of online materials (Community Reviewers). Participants were kept informed about ongoing progress through a website. 

The following sessions helped to shape refined definitions and areas of focus after the initial environmental scan was complete.  

  • African Mental Health Summit (2017)- Open-ended conversation with a large group regarding goals, definitions, and gaps.
  • American Indian Mental Health Conference (2017)-Structured conversation with a smaller group around goals, definitions, and priorities.
  • DHS Mental Health Division –Structured conversation with a larger group around definitions and priorities.
  • Parent Catalyst Leaders Group (Hennepin County) – Listening session with parents who were newer to the system and guided by more experienced parents around gaps and challenges.

There were seven (7) Co-Creation Groups (in 6 communities) Rochester, Duluth, Mahnomen, Minneapolis, St Paul (2), and New Brighton.  A total of 89 people participated in these groups. Participants included a spectrum of people with a variety life experiences and backgrounds. These processes were developed to support the maximum engagement of each participant.  The following people attending a co-creation session:

  • Thomas Anderson, Minneapolis
  • Laura Armstrong, Minneapolis
  • Mina Blyly-Strauss, Minneapolis
  • Carol Brogan, Chatfield
  • Brenda Caya, Duluth
  • Mary Chazen, St. Paul
  • Rose Chos, Duluth
  • Cristina Combs, St. Paul
  • Jennifer Conger, Savage
  • Heidi Crees, Minneapolis
  • Debbie Crittenden, Bloomington
  • Tom Crittenden, Bloomington
  • Nicole Duchelle, Lake City
  • Polina Duchelle, Lake City
  • Amber Dukowitz, Duluth
  • Josephine Eades, Duluth
  • Karen Ellian, Duluth
  • Feisal Elmi, Minneapolis
  • Angela Elwell, Eagan
  • Amelia Fink, St. Paul
  • Kassandra Flake, Minneapolis
  • Mike Francis, Eagan
  • Carl Gardner, Minneapolis
  • Colleen Garman, Minneapolis
  • Gerald Geist Jr., Moorhead
  • Cathy Gillman, Cottage Grove
  • Triasia Givens, Minneapolis
  • Susan Govern, Minneapolis
  • Amy Granquist, Duluth
  • Jane Haas, Stillwater
  • Kristin Hale, Duluth
  • Ricky Hamm, Rochester
  • Keven Hardy, Rochester
  • Tom Haselman, Minneapolis
  • Vivian Henry, St. Paul
  • Jenny Isaacson, Duluth
  • Melissa Johansson, Maplewood
  • James Johnson, Duluth
  • Carolyn Keefner, Westminster, Co.
  • Jessica Kisling, Minneapolis
  • Bob Klade, McIntosh
  • Kay Knight, Duluth
  • Fonda Knudson, Fergus Falls
  • Jeanne Kolo-Johnson, Moorhead
  • Maggie Lemasters, Duluth
  • Jenny Linder, Duluth
  • Tulu Lope, Inver Grove Heights
  • Ginger Madeiros, St. Paul
  • Diane Marshall, St. Louis Park
  • John Martin, Minneapolis
  • Kristy Matzke, Rochester
  • Lamont Mayo, Minneapolis
  • Nick Mazzoni, Duluth
  • Alvin McCoy, Minneapolis
  • Willard McDonald, Rochester
  • Kurt Meyer, Minneapolis
  • Cari Michaels, St. Paul
  • David Moses, Rochester
  • George Nadeau, Minneapolis
  • Beth Nelson, Fergus Falls
  • Richard Oni, Birchwood
  • Peggy Ostman, Duluth
  • Jovi Parm, Minneapolis
  • Rose Plentyhorse, Minneapolis
  • Tyler Rinta, Minneapolis
  • Ruby Rivera, St. Paul
  • Michael Ruhl, Minneapolis
  • Ryan Sandquist, Minneapolis
  • Julie Scharver, Fergus Falls
  • David Schreyer, Two Harbors
  • Kelsey Shoden, Rochester
  • lenda Smith, Fergus Falls
  • Cora Spear, Burnsville
  • Jennifer Thomas, Maple Grove
  • Nelly Torori, St. Paul
  • Maria Tripeny, Bloomington
  • James Van Druten, Duluth
  • Sarah Vinueza, Minneapolis
  • Kenya Walker, St. Paul
  • Claudia Waples, South St. Paul
  • Eileen Ward, West St. Paul
  • Terry Wasnick, Duluth
  • Linda Weber, Rochester
  • Bryant Wheeler, Minneapolis
  • Tobias Wilde, Moorhead
  • Shannon Williams, Duluth
  • Tera Wiplinger, Rochester
  • (Wendy) Maxuan Wu, Minneapolis
  • Ann Zick, Osage

The authors for the online lessons were:

  • Susan O’Nell, Project Director
  • Jody Van Ness, Project Staff
  • Merrie Haskins, Project Coordinator

There were seven community reviewers recruited to review the content of online materials that were developed. These reviewer were mental health professionals and included family members of service users. The following people served in this role:

  • Allison Brockway – Sherburne County
  • Tamba Gordon – Hennepin County
  • Tom Haselman – Hennepin County
  • Jessica Kisling – University of Minnesota
  • Jane Lawrence – Community Reviewer
  • Jeff Olson – Headway Emotional Health
  • Dorothee Tshiela – Face to Face Health and Counseling

In addition Darrin Helt of the DHS Behavioral Health Division served as editor and approver. 

Web development, design, and media team:

  • Amanda Webster
  • Shawn Lawler
  • John Westerman
  • Kristin Dean
  • Sarah Hollerich