Taking Action Against Stigma

Overview

The C3 2024 Winter Event was on December 4, 2024. United Way of Tucson & Southern Arizona in Tucson hosted. About 75 people came in-person and online. Attendees were providers, advocates, people with lived experience, educational institutions, public entities, and community-based organizations. The event focused on our first C3 cycle efforts and successes. We addressed stigma across all communities. We reviewed the group’s efforts over the last two years. C3 workgroups identified issues and deployed a plan to address them. Arizona Complete Health shared the C3 achievements outlined below. They named the winners of the first annual Workforce Development Award: COPE Community Services Inc., Devereux Advanced Behavioral Health, & Via Elegante Assisted Living & Memory Care. CODAC shared the value of partnership. They gave us tools for building partnerships with neighborhoods and fighting stigma that comes with a health home. United Way of Tucson and Southern Arizona along with the University of Arizona’s Innovations in Aging program talked about the Elder Alliance and ways we can change our speech to tackle ageism. Text, Talk, Act used texts to create a small group conversation around mental health. The 2025/2026 C3 focus was announced: Neutralizing risk, Empowering, and Thriving (C3 NET). This includes better transparency, finding chances for collaboration and safety nets, and continuing the 23/24 efforts. The efforts are accessing health data, growing health literacy, building social determinants of health programs, and customizing member engagement tactics for different groups.

Highlights of our 2023/2024 C3 achievements include:

• Wrote and published grad program materials to promote recovery concepts into course program. Partnered with the Joint Technical Education District (JTED) to engage grad programs.
• Be CLASy tool made and issued to promote diverse and inclusive workplaces.
• Built a listing of speakers to participate in talks with students. JTED will direct this.
• Started and funded a Coordinated Internship Program. This brings more openings for students thinking about careers in health care.
• Worked to improve Peer Employment Training courses and oversight. Started statewide competencies and refreshed curriculum. This will soon be a requirement.
• With AzCH & community involvement, AHCCCS will lead efforts to start a standardized test for Peer Support Specialist certification.
• Built and launched tiered training program.
• Created and dispersed marketing materials. The materials pair stories of personal recovery journeys with outcomes data.
• Funded community-based organization, Text, Talk, Act (TTA). TTA offers school-based recovery and anti-stigma programs.
• Participated in and shared info about Mental Health Day at The Capitol.
• Commercial about First Episode Psychosis. Shared where to get help.
• Civic Leadership training for peers and family members.
• Series of “roadshows” and roundtables across the State. These promoted access to info, community view points, and collaboration.
• Youth Engagement Specialists in schools.
• Developed health literacy training program. This was based on peer and family input via roundtables.
• Created a cross-sector data dashboard. This shares real-time data across stakeholders.
• Created a novel analytics report. It allows providers to intervene earlier and more effectively.
• Launched Excellence in Workforce Development Award.
• Statewide efforts to develop a program focused on recruitment, development, and retention strategies. This was in partnership with the Association for Talent Development and the Workforce Development Alliance.
• Launched Care Coordination certificate program with Pima Community College.
• Tracked court priorities and state budget plan. Encouraged higher rates with downstream to salaries.
• Established Value-Based Purchasing  group. Worked to find improvements in alternative payment methods that support provider scheduling flexibility.

Recognizing Excellence & Innovation in Workforce Development

AzCH launched the Workforce Development Award. This recognizes providers for advances in workforce development. The 2024 winners were:

• COPE Community Services Inc. for their Coordinated Internship Program.
• Devereux Advanced Behavioral Health for their ASCEND Career Accelerator Program.
• Via Elegante Assisted Living & Memory Care for their overall Workforce Development projects.

CODAC – Addressing NIMBYism: How Health Homes Make Neighborhoods Better

CODAC has four transitional living programs. They are a fully integrated health home. They provide tools, support, and services to individuals, families, and communities. CODAC allows them to live with dignity, free from the harmful effects of substance use disorders and mental illness. CODAC acknowledged that elements of untreated SUD and mental illness are harmful. Stigma begins in our communities and neighborhoods. It is important to keep our ears open and hear what our neighbors are saying. To reduce stigma and partner with the neighbors, we must listen.

Ways to reduce NIMBYism:

1. Ask & Listen. Get to know your neighbors. Find opportunities to meet with people. Find your champions. Meet with neighborhood associations. What are their concerns? Give them a chance to talk. This can be tough. Be willing to invest your time.
2. Acknowledge: Put yourself in their shoes. They may have emotional responses, generalizing, and assuming. They are paying for more security. They replace broken or stolen assets. People fear being attacked at night. 
3. Inform: Share real stories about clients. Those living with mental illness and SUD. Treatment is effective. It lessens the things about which they are concerned. Clients are less likely to loiter, be unhoused, take part in crime.
4. Help: Offer to help and follow up. Under promise and over deliver. Don’t promise to do things out of your range. 
5. Communicate: Celebrate when things are going well. Admit when things are not going well. Provide a contact to address issues promptly.

CODAC’s struggles and successes of opening new health homes in three locations:

1. CODAC sought two parcels of land to open a new treatment facility. This was less than a mile from the existing facilities. General mental health, SMI clinic, and methadone clinic. One parcel was not zoned for parking. It was a 7-month process to switch the zoning. 9+ meetings with neighborhood association to discuss what CODAC’s plan was. Misperceptions have an impact on the business. They got involved in the community. They organized cleanup events. They made concessions - no methadone, no groups after 5pm, extra security. The facility and parking opened.
2. CODAC at 380: They engaged neighborhood association ward and the Tucson Police Department. The neighbors were nervous about more needles in parks. CODAC built nine dosing units. They removed misperceptions. They had 24/7 security. Members could dose safely. They heard concerns, made concessions, put in work, and now have a great partnership.
3. CODAC at Speedway: COVID created hiccups. They were told not to reach out to the community. Until things got rough. Architect was taking care of community neighborhood meeting. This was a residential treatment program. The meeting was recorded and posted online. People thought it was going to be a prison. Neighborhood was concerned about the women and children housed there. The neighborhood was struggling long before CODAC opened a campus there. It used to be a vacant building that people were living in. When they finished renovations, they did outreach with TPD. This changed perceptions. Our facilities brought security. CODAC provided NARCAN training for neighboring businesses.

Some circles are more understanding and trust treatment. Society's most vulnerable deserve dignity and respect. We need to change the dialog and educate the public. 

United Way of Tucson & Southern Arizona and UofA - Elder Alliance & Tackling Ageism

United Way gathers financial resources from the community and listens to the community to address issues. Their main focus areas are educational success, healthy living, homelessness and housing stability, and financial stability. A part of their healthy living initiative is the Elder Alliance. This program helps older people remain active and involved, and keep their max mobility. It is a team of community members working to elevate the elder viewpoint. The Elder Alliance ensures the elder’s voice is heard and needs are met. Elder Alliance action teams focus on the below:

1. Advocacy – Ensures the elder’s voice is heard and needs are met in legislation.
2. Age Friendly/Livable Communities - If a community is good for an 80-year-old, it will be good for an 8-year-old.
3. Dementia – Memory cafes and offer screenings.
4. Direct Care Workforce - Recruit direct care workers, pay for training, barrier reductions, and connect with provider agencies.
5. End of Life Care – Normalize the talk about death and dying. 
6. Voices Community Connectors – Women with vast lived experience from urban Tucson. They connect with older adults and bring back issues. 

Ageism is #1 ism. It affects everyone. It is an accepted bias. Eighty-two percent of adults aged 50-80 experience one or more forms of daily ageism. By 2034 there will be more individuals over the age of 65 than under the age of 18. There are five age groups still working: Traditionals, Baby Boomers, Gen X, Gen Y, & Gen Z.

• Institutional Ageism:
  • Mandatory/encouraging retirement
  • Refusing to hire individuals based on age
  • Housing
  • Media – anti aging everything
• Interpersonal Ageism
  • Belittling older & younger individuals
  • Elderspeak
  • Avoiding interactions 
  • You look great for your age
  • She’s too young for manager
• Self-directed Ageism
  • Towards self
  • I’m too old for that
  • You’re younger than I am; I’m too old for that job, etc.

Suitable speech when talking about age:

Confronting Ageism in Health Care:

Ageism is a road block to good health. Twenty percent of people over 50 are not listened to. Ageism can be dismissing fixable conditions that would be checked out promptly in younger patients. Clinical trials do not include older adults. Look at your hiring practices. Look at your policies and procedures. Ensure they are inclusive. This includes font size and the way in which files are offered. Learn about ageism. Use age-friendly language. Do not assume based on age. The University of Arizona is working to combat ageism. They have two certificate programs on Insights into Healthy Aging.

Text, Talk, Act

Created at the University of Arizona in partnership with SAMHSA, Text, Talk, Act (TTA) engages students in a variety of peer-to-peer conversations that build social connectedness and life skills. This one-time campaign turned into its own nonprofit. Over 300,000 youth have completed the program since its founding. This includes activities for grades 4-12. Each age-appropriate activity is guided by one to two TTA trained facilitators. The sessions are 50 minutes long. Students form small groups and text (if they have phones) into TTA. They then receive a series of pre-programmed texts that lead them through the activity. The class ends with a large group debrief. Most students report a better grasp of mental health and coping tactics. Most students also report more confidence in helping a friend in need. CEO, Raquel Goodrich led the C3 attendees through a text session in small groups. 

C3 2025/2026

The focus for the 25/26 cycle is C3 Neutralizing risks, Empowering, and Thriving communities (C3 NET) and Whole Person Care.

What People Are Saying

Participants reflected on their learning from the C3 event. Here is what they said:

• “I learned that focusing on roadblocks and barriers, although important, can hold you back from achieving your goal. Rather, focus on what you can do and how as a community the impact can be greater.”
• “I realized that I hadn’t thought much about ageism and learned a lot.”
• “I learned about the great work of Text, Talk, Act!!”
• “I learned about language on ageism and how to ensure we are not discriminating even though it is rampant in our culture.”

We asked people to share what they learned with their organizations. Identify concrete ways that they can further C3 efforts within their circles. Here is their vow:

• “I will work with my organization to engage our entire neighborhood/neighboring businesses in discussions about mental health.”
• “My organization will implement some of the community engagement strategies shared today to impact NIMBYism.”
• “I will implement strategies to address ageism – including developing new curriculum to help the people we serve advocate for their needs and brainstorm ways to address health disparities among older adults.”
• “I am thinking about how to increase awareness around ageism in my organization.”
• “I will identify ways to leverage Text, Talk, Act and bring this program to new groups.”
• "I will connect more people to the C3 efforts and share information."
• “I will share information about my organization with the local neighborhood association and join future meetings.”
• “I will introduce Text, Talk, Act to our youth programs.”