This Proceedings of Two Workshops summarizes presentations and discussions at workshops convened in 2015 by the National Academies of Sciences, Engineering, and Medicine, with oversight from the Committee on the Science of Changing Behavioral Health Social Norms. The workshops provided input to the committee’s deliberations and contributed to the development of the report Ending Discrimination Against People with Mental and Substance Use Disorders (National Academies of Sciences, Engineering, and Medicine, 2016). That report was issued to help the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, utilize the scientific evidence base in improving public attitudes toward and understanding of behavioral health, specifically in the areas of mental health and substance use disorders.
The objective of the first workshop, titled Lessons Learned from Diverse Efforts to Change Social Norms, was to gather information that could be gleaned from communication campaigns in public health arenas other than behavioral health. Panelists had expertise in basic and applied communication science and experience with communication campaigns focused on changing social norms in issue areas that included HIV/AIDS, youth smoking, gay and lesbian bullying, and epilepsy. The workshop was convened on March 18, 2015, in Washington, DC. The statement of task for this workshop is presented in Box 1-1.
This workshop was planned by a steering committee comprising several members of the Committee on the Science of Changing Behavioral
Health Social Norms. The final workshop agenda was determined by the availability of expert speakers in the various content areas. Accordingly, the proceedings in this volume contains presentations on successful public health campaigns to change attitudes in HIV/AIDS, epilepsy, youth smoking, and gay and lesbian bullying.
The objective of the second workshop, titled Opportunities and Strategies to Promote Behavior Change in Behavioral Health, was to provide input for the committee on media, communication, and other types of campaigns aimed at changing attitudes and behaviors related to mental health and substance abuse in the United States and in other countries. Panelists had expertise in the design, implementation, and assessment of such campaigns that enabled them to help the committee understand both the determinants of success and the challenges involved. The workshop was convened on April 15, 2015, in Washington, DC. The statement of task for this workshop is presented in Box 1-2. This workshop was planned by a steering committee comprising several members of the Committee on the Science of Changing Behavioral Health Social Norms.
At the first workshop, Kana Enomoto, deputy principal administrator at SAMHSA,1 explained the importance of and rationale behind SAMHSA’s efforts to improve social norms with respect to people with mental health and substance use disorders. She emphasized that SAMHSA believes in the need to invest in world-class, evidence-based prevention, treatment, and recovery services for people who are most affected by these conditions. She indicated that the Mental Health Parity and Addictions Equity Act addresses some of the legal disparities between behavioral health and physical health services, but that social disparities remain, which led SAMHSA to this work with the National Academies.
Enomoto indicated that SAMHSA is investing in this work with the committee as a bridge to the science that can better inform its messaging and how this messaging can be made more compelling. SAMHSA wishes to
1 Enomoto is currently the acting deputy assistant secretary at SAMHSA. Her remarks were made after the first panel presentation, but are summarized here because they were introductory in nature.
strengthen its reliance on messaging that is science based in order to help people access evidence-based programs and services.
This proceedings was compiled by the rapporteurs as a factual summary of what occurred at the two workshops based on transcripts, PowerPoint presentations, and video recordings. In accordance with the National Academies policy, any conclusions and recommendations contained herein were solely expressed by and are attributed to individual presenters and participants. The workshops were webcast live and were posted on the National Academies website.2
The actual preparation of this proceedings took place in 2017 during a follow-on activity, Changing Behavioral Health Social Norms: Phase II Workshop and Pilot Development. This proceedings summarizes the presentations of the invited panelists and highlights of the workshop discussions; it is organized to correspond with the workshop agenda items (Appendix A).
Part I summarizes the first workshop, Lessons Learned from Diverse Efforts to Change Social Norms. Chapter 2 describes the first panel’s presentations on lessons learned about messaging to change social norms from previous efforts in relevant public health fields. Topics covered include key principles in the design of effective persuasive messages, the influence of message structure and content, behavioral economics and social marketing, and the context and testing of public service announcements. Chapter 3 focuses on methods and various platforms (e.g., television, journalism, national advertising) for delivering messages and on the strengths and weaknesses of the various media types in the context of the social norms targeted for change. Chapter 4 turns to a broader view of strategies for changing social norms, including mass media campaigns, as well as other potential drivers of change, such as public policy, regulatory changes, and grassroots campaigns. Finally, Chapter 5 presents case studies of media and communication campaigns/strategies used to improve social norms, beliefs, and attitudes in two health-related arenas in which negative social norms, chronicity, and behavior change are relevant—epilepsy and HIV/AIDS.
Part II contains the proceedings of the second workshop on Opportunities and Strategies to Promote Behavior Change in Behavioral Health. Chapter 6 summarizes the stage-setting remarks of Alan I. Leshner, chief executive officer (emeritus) of the American Association for the Advancement of Science, who presented his thoughts on how best to use science in changing social norms around behavioral health and the inherent complexity of carrying out this type of research. Chapter 7 summarizes the presenta-
2 See http://sites.nationalacademies.org/DBASSE/BBCSS/CurrentProjects/DBASSE_089113 [September 2017).
tions of four panelists on the successes and challenges of national, state, and local campaigns aimed at changing these social norms. Chapter 8 focuses on the implementation and evaluation of past initiatives and campaigns to change social norms about behavioral health in the United States. Chapter 9 summarizes a lunchtime presentation on the rationale and methods used by the Frameworks Institute to improve communications for public understanding and policy change with respect to child mental health. Chapter 10 reviews potential strategies for implementing change by reaching strategic audiences. Presentations during this panel reflected the lived experience of consumers, advocates, family members, and practitioners. Finally, Chapter 11 summarizes the successes and challenges of efforts aimed at changing social norms outside of the United States, in the United Kingdom, Canada, and Australia.
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