AK Discretionary Funding Fiscal Year 2020

The Alaska Native Tribal Health Consortium (ANTHC) will partner with the Aleutian Pribilof Islands Association, Inc. (APIA), both tribal health service providers, to provide crisis intervention services, mental and substance use disorder treatment and other related recovery supports for Alaska Native and American Indian children and adults impacted by the COVID-19 pandemic. The project will focus on implementing the five required activities outlined in the funding announcement while developing sustainable infrastructure to continue to offer behavioral health teletherapy statewide once the project period ends.

57.9 million Americans live with mental and/or substance use disorders (NSDUH, 2018). The COVID-19 crisis will contribute to increases in depression, anxiety, trauma, grief, and substance misuse. This project serves Alaskans statewide by providing crisis intervention services, mental/substance use treatment, crisis counseling and other supports to children/adults impacted by the COVID-19 pandemic. The primary approach of Alaska's Emergency COVID-19 project is grant provision to providers of Community Behavioral Health services who submitted Letters of Commitment to this project. The state aims to provide Emergency COVID 19 services to 32 pre-existing psychiatric emergency services (PES) service areas around Alaska. Each grantee, in addition to providing COVID-19 PES, will provide (or collaborate/contract with other agencies to provide), some/all of the COVID-related comprehensive services outlined in SAMHSA's FOA to one or more of the target populations: individuals with serious mental illness (SMI), with substance use disorder (SUD), or with co-occurring disorders. The provision of community/ recovery support services will be required of each grantee directly or through collaboration/ contracting. The following are strategies which may be provided/enhanced through this grant: Psychiatric Emergency Services (e.g., 24/7 crisis line, crisis intervention/stabilization/mobile response); services to individuals with SMI (e.g., individual/group psychotherapy, psychiatric services, and case management, and support for daily living skills including problem solving regarding finances/ acquiring groceries/ transportation/social connections); service to Seriously Emotionally Disturbed Children (including EBPs, expanded day treatment, residential stabilization/treatment and therapeutic foster care); services for individuals with Substance Use Disorders (e.g., adult outpatient SUD treatment, residential SUD treatment, residential/ ambulatory withdrawal management, and MAT); Community/ Recovery Support Services (e.g., housing/ peer/ employment support, and relapse prevention); Specialized Peer Support Services (e.g., family peer support, warm lines, SUD recovery coaches). Grant funds will be utilized to increase telehealth capabilities and expand use of distance technologies and strategies to meet Covid-19 needs. This is a special challenge and need in Alaska, with its vast geography and largely rural population. Project progress will be assessed by SAMHSA-required GPRA data and Division of Behavioral Health metrics, including agency quarterly reports/ AKAIMS/ electronic health records. Though the virus/disease were unknown before the 12/2019 China outbreak, Alaska now has 213 cases, with cases in its largest communities (Anchorage/ Fairbanks/ Juneau), and smaller communities. Though the pandemic's rapidly changing nature make it difficult to precisely estimate the number served by this grant, it is certain that Alaska's system is stretched; this grant will assist not only those directly impacted by the pandemic, but also the hundreds if not thousands needing services to address emerging/re-emerging Mental Health/Substance Use issues resulting from the stress, anxiety, depression, & trauma resulting from the situation.

Cook Inlet Tribal Council, Inc. (CITC) is a tribal nonprofit social services organization serving the Municipality of Anchorage. Responding to SAMHSA's Emergency COVID-19 opportunity, CITC proposes its "COVID Response" project, which will address the anticipated need for additional services in Anchorage resulting from the ongoing COVID-19 pandemic. In alignment with SAMHSA's goals for the current opportunity, CITC will reduce the unmet need for substance abuse disorder (SUD), co-occurring disorder (COD), and serious mental illness (SMI) treatment services in Anchorage by enhancing its existing continuum of care. Specifically, CITC will conduct those activities listed below. 1) Provide comprehensive and evidence-based SUD, COD, and SMI treatment (including telehealth) services for individuals who are or will be adversely impacted by the ongoing COVID-19 pandemic. 2) Provide screenings and assessments for SUDs, CODs, and SMIs that are based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) in order to inform appropriate treatment. 3) Provide a comprehensive continuum of culturally appropriate SUD and COD prevention and treatment services, including medication-assisted treatment (MAT), pre-treatment, recovery housing, and peer-based alumni continuing care. 4) Provide an extensive array of supportive services that will remove barriers to successful recovery. Examples of those supportive services include nutrition coaching, social linkages, workforce development, sober housing, childcare, transportation, civil legal assistance, and primary healthcare (including telehealth). 5) Continue to provide internal, 24-hour, and on-call SUD, COD, and SMI services and collaborate with regional emergency crisis teams.

Fairbanks Native Association (FNA) is applying for the SAMHSA Emergency COVID-19 grant on behalf of Alaska Native and American Indian (AN/AI) people in the Fairbanks North Star Borough (FNSB) of Alaska. The purpose of the proposed project is to provide crisis intervention services and related recovery support for children, youth, and adults impacted by the COVID0-19 pandemic. The focus is on individuals with substance use disorders. The focus of the proposed Alaska Native Pandemic Project (ANPP) is on individuals with substance abuse disorders and individuals with serious emotional disturbance. As an Alaska Native organization, our primary service population is Alaska Native. However by mutual agreement Alaska Native organizations also serve American Indians when they are in our service area, and vice versa. AN/AI are particularly vulnerable to this crisis requiring an immediate emergency response to stabilize those impacted by the pandemic. This pandemic will increase depression, anxiety, trauma and grief for Alaska Natives as a result of the virus and the corresponding results of the pandemic which are impacting our way of life and well-being, including loss of income, housing, lock downs (heavily impacting behavioral health) food shortages, and hope for the future. The world as we know it has entirely changed and Alaska Natives are a population least equipped to emerge from the virus unscathed. Alaska Natives are disproportionately negatively impacted by all indicators of well-being, as documented in Section A of this proposal. FNA Behavioral Health has systems in place to address the behavioral health needs of clients negatively impacted by the epidemic, including Evidence-Based outpatient and residential treatment (including co-occurring), Screening and Assessment, Recovery Support Services (limited to the MAT Outpatient treatment unit), and a comprehensive system of care to provide necessary supports for ongoing recovery during and post-treatment. Two service gaps are apparent and will be the focus of new services. (Crisis Mental Health and Recovery Support. New services will include a) the development of a comprehensive community-wide plan of evidence-based substance use disorder and co-occurring SUD and mental health disorder treatment services for individuals impacted by the pandemic, b) Recovery Support services for all FNA BH service units (serving 72 clients), and c) Crisis Mental Health Services (serving 60 clients) that include a 24 hour on-call crisis team and Crisis Intervention, Stabilization and Therapy. Recovery Support services are enhanced through our community-wide System of Care championed by our long-standing community coalition, the Interagency Transition Council (ITC). The FNA-sponsored ITC includes a community leadership network of 16 service agencies and individuals within the service domains critical to both MH and SUD (described in Section B. The ITC will spearhead community leadership, outreach for client recruitment and the plan referenced in (a) above.

Kenaitze Indian Tribe (Kenaitze) is a federally recognized tribal government reorganized in 1971 under the statutes of the Indian Reorganization Act of 1934, as amended for Alaska in 1936. The project "Kenaitze's COVID-19 Emergency Response" is intended to address significant increases in the number of Tribal, Alaska Native/American Indian (AN/AI), and other community members suffering from depression, anxiety, trauma, grief, substance abuse, and/or PTSD stemming from COVID-19-related stressors. A Comprehensive Strategic Planning process will identify service gaps related to serious mental illness (SMI), and expanded Case Management will support distance-delivered treatment and support services to those with SMI, substance use disorder (SUD), and/or co-occurring SMI and SUD. Grant-funded activities will be concentrated at the Tribe's Dena'ina Wellness Center (DWC) health facility in Kenai, Alaska, serving a 15,000-mile geographical area in rural Alaska. The project goal and measurable objectives include the following: Project Goal: Expand capacity to provide Behavioral Health and support services. Objective 1: Hire two (2) 1.0 FTE Behavioral Health Case Managers by the end of three (3) months. Objective 2: Develop a Comprehensive Strategic Plan including information and service gaps related to treatment and support services linked to SMI within the Kenaitze service area by the end of four (4) months. Objective 3: Provide telephonic evidence-based Behavioral Health support services for at least 40 unique persons affected by SUD and/or SMI by the end of 16 months. Case Managers' activities will include 1) conducting intake screenings; 2) facilitating telephonic "warm handoffs" to Clinicians; 3) engaging in telephonic coaching; 4) connecting to resources and services; 5) administering transportation punch cards for necessary travel; and 6) conducting data collection. Case Managers will trained by the Project Director to utilize the "Strengths-Based Case Management Model"; and to conduct intake screenings telephonically using the Patient Health Questionnaire-9 (PHQ-9); Screening, Brief Intervention, and Referral to Treatment (SBIRT); Alaska Screening Tool (AST); and the Columbia Suicide Severity Rating Scale (C-SSRS). Case Managers will facilitate warm handoffs to Behavioral Health Clinicians and/or Chemical Dependency Counselors using Cognitive Behavioral Therapy (CBT) for those with advanced treatment needs to be addressed telephonically or, where applicable, face-to-face. Any Tribal/AN/AI persons requesting medication-assisted treatment (MAT) for opioid use disorder (OUD) will be referred to Kenaitze's existing program, a partnership with DWC Primary Care. Using the CSAT GPRA "Client Outcomes for Discretionary Measures" interview tool, Case Managers will collect data at initial screening, at 3-month intervals, and at discharge to determine the project's efficacy.

The project responds to mental health and substance use disorder crisis needs of the service area by creating an emergency Crisis Stabilization Unit-type response in order to address the simultaneous loss of access to all higher level in-patient or residential psychiatric and substance use disorder care. Travel and community quarantine restrictions unique to the State of Alaska result in a loss of access to the existing state-sanctioned network for the provision of higher level care for SMI/SUD patients requiring inpatient or residential care. Out of necessity, we are responding by standing up an emergency Crisis Stabilization Unit-type (CSU) facility that will have to be able to respond to all SMI/SUD and co-occurring diagnoses patients in crises requiring 24/7 observation and care. The population to be served through the larger enhancement of existing telehealth capacities for psychiatric and therapeutic care includes the approximately 500, predominantly Alaska Native individuals diagnosed with SMI/SUD or co-occurring diagnoses residing in the Northwest Arctic Alaska service area (Northwest Arctic Borough and the Village of Point Hope). We estimate approximately 50 individuals may be served at the CSU facility in an annual period and 75 during the 16 months of the project. The project Goal is to provide expanded crisis intervention services to address the challenges of SMI/SUD and Co-occurring diagnoses patients impacted by the COVID-19 pandemic. Objective 1A is to implement by then end of the fourth project month one comprehensive plan of evidence-based services to address mental health and/or substance use disorder treatment services for individuals impacted by the COVID-19 pandemic, including telehealth capabilities. And Objective 1 B is to by end of project month 3, establish functioning emergency Crisis Stabilization Unit-type facility (CSU) to address need for SMI/SUD and co-occurring diagnoses services for those unable to be evacuated to higher level care facilities.

Native Village of Tyonek (NVT), a federal recognized tribe in Alaska, will serve a population of 373 community members and other residents in the area by providing timely responses to emergency medical incidents in the area by increasing the capacity of rural emergency responders. A responder trained and competent will provide any emergency aid necessary to sustain life and minimize impact of physical and behavioral conditions. The strategy is: 1) to assure adequate 24/7/365 coverage by increasing the pool of EMS responders by 3 locally trained personnel; 2) to assure competent personnel respond to all EMS calls, six personnel lacking formal certification will be trained to EMT level 1; 3) to assure competent emergency medical response to opioid overdose, all EMS staff will be trained to recognize overdose and administer Narcon (naloxone); 4) to assure emergency responders in this isolated village area trained to the highest level of proficiency possible, existing certified EMS responders will receive upgraded training resulting in an additional three EMS personnel certified as EMT-2 or EMT-3; 5) to assure that people in the village having a mental health crisis are provided best practice emergency care, all EMTS will received Mental Health First Aid Training. Because Tyonek is a small, close knit Tribal community, recruitment methods focus on "word of mouth" dissemination within the village. Each Tribal Leader and other staff will also participate in spreading the word. Training will be conducted using several resources such as state training materials and trainers as well as approved curriculum. Each trained EMT is also commissioned to keep on training each other and other tribal members as the need for more EMTs becomes evident. With the high rate of suicide as well as impacts of the most recent Coronavirus (COVID-19) pandemic overwhelm the NVT health system, more people may need to get training in Mental Health First Aid. This project, as does other NVT projects, include a strong partnership with Southcentral Foundation, the Nikiski Fire Department, and the Cook Inlet Tribal Council.

In relationship to Ninilchik Traditional Council's (NTC) ongoing mission to promote access to health and education resources, the NTC Community Clinic has been providing Medically Assisted Treatment (MAT) since 2014. Together, with our partners, we have been able to provide medication and behavioral therapies to individuals experiencing Substance Use Disorder, Opioid Use Disorder, and mental illness (below the threshold of severe mental illness) throughout the Southern Kenai Peninsula. With $500,000 in Emergency COVID-19 funding, NTC will enhance and expand our telehealth capacity and ensure that recovery services are available to all individuals in the above-described client population based on diagnosis, need, risk of relapse, and assessment recommendations. According to the Center for Disease Control, Alaska's Kenai Peninsula has the highest rate in Alaska per capita of opioid prescriptions, which are higher in primarily white, rural communities with high unemployment rates. The majority of our current clients are white and Native Alaskan; male and female clients are nearly equal in representation. With the service delivery improvement and expansion made possible by this award, we anticipate that we will be able support an additional 75 impacted individuals in our service area per year and enroll 100 new clients over this project period. With Targeted Capacity Expansion funding for MAT, NTC will enhance their current addictions program to: 1) Increase access to medical and behavioral health treatments for those experiencing SUD, OUD, and mental illness through the expansion of telehealth: a. 70% of direct service funding to provide direct services to those with SUDs b. 10% of direct service funding for healthcare practitioners with mental disorders (less severe than SMI) requiring mental health care as a result of COVID-91 c. 20% of direct service funding to be used for all other individuals with mental disorders less severe than SMI 2) Mitigate risk of diversion with the transition to the Sublocade injection and Directly Observed Therapy (via emocha) for patients using Suboxone strips 3) Implement remote Blood Alcohol Content (BAC) monitoring through the purchase of Soberlink devices 4) Acquire Bridge Devices for opioid withdrawal to minimize utilization of Emergency Departments 5) Increase service access for remote villages with no access to the road system

Southcentral Foundation (SCF), through its primary care center and behavioral health programs, respectively, the Anchorage Native Primary Care Center (ANPCC) and Fireweed Center, will work with other SCF health programs to reduce unmet mental health and substance use disorder treatment needs related to COVID-19 through the provision of screening, prevention, treatment and recovery activities by increasing access to culturally appropriate and evidence-based treatment over a sixteen month period. The ANPCC is a major health center located on the Alaska Native Health Campus located central to Anchorage charged with the health of the Alaska Natives and American Indians (AN/AI) in the Anchorage Indian Health Service Unit. Along with the Alaska Native Medical Center (co-owned and operated by SCF and the Alaska Native Tribal Health Consortium) are the central points for testing and treating those impacted by COVID-19. For this project, ANPCC will refer all or most of those needing treatment for mental health and/or substance use disorders exacerbated by COVID-19 to the SCF Fireweed Clinic, also located on the Alaska Native Health Campus. Fireweed Clinic provides behavioral health services for Alaska Native and American Indian people including adults, children, and adolescents. This project will strengthen the integrated health system during this time of great need by pulling much needed behavioral health capacity into the process of addressing the impacts of COVID-19 within the Native community of Anchorage. The primary objectives are: 1) Review, assess, and document current service delivery to address gaps and use of telehealth; 2) Screen and assess 500 AN/AI Customer-Owners who visit the ANPCC needing mental health and/or substance use disorder treatment based on the SAMHSA required ratio of service recipients; 3) Provide mental health and substance use disorder treatment and related services to 500 AN/AI Customer-Owners who visit the ANPCC needing treatment; 4) Provide recovery services to 500 AN/AI Customer-Owners who receive mental health and substance use disorder treatment; and, 5) Analyze and enhance the development of the SCF Mental Health Crisis Services to address pandemics such as COVID-19 to include further exploration of elements of crisis management. The plan includes sharing lessons learned, experiences throughout the process, and successful events as a result of the project.

Southeast Alaska Regional Health Consortium (SEARHC) Behavioral Health serves Southeast Alaska, which is comprised of rural island communities of over 70,000 residents with uniquely low access to prevention, treatment, and recovery support services for substance use disorder (SUD), and co-occurring substance use and serious mental illness (SMI). In most Southeast Alaska communities, SEARHC is the only provider of behavioral health and primary health care services, and has a user population of 28,600 in the service area. During the current national crisis of COVID-19, SEARHC Behavioral Health will provide crisis intervention services, SMI and SUD treatment, co-occurring SMI and SUD treatment, and other related recovery supports for children and adults impacted by the pandemic (70% direct service). SEARHC Behavioral Health will also address the needs of individuals, including healthcare practitioners, who coincidentally mostly work for the organization, with mental disorders less severe than SMI (10% direct service) and for all other individuals with mental disorders less severe than SMI (20% direct service). Services will be provided from the Hub, Sitka Behavioral Health, supporting (4) of SEARHC's community-based clinics, or Spokes: Juneau Behavioral Health, Haines Behavioral Health, Wrangell Behavioral Health, and Juneau Front Street Clinic; and through the Community Family Service Program in (7) rural communities: Angoon, Craig, Hoonah, Hydaburg, Kake, Klawock, and Petersburg. SEARHC Behavioral Health intends on implementing coordinated delivery of behavioral health and substance use disorder treatment services with evidence-based strategies and cohesive approaches to the COVID-19 pandemic. SEARHC Behavioral Health will provide crisis intervention services, mental and SUD treatment, and other related recovery supports for children and adults impacted by the COVID-19 pandemic. Programming will specifically address the needs of individuals with serious mental illness, individuals with substance use disorders, and/or individuals with co-occurring serious mental illness and substance use disorders. Additionally, the program will also focus on meeting the needs of individuals with mental disorders that are less severe than serious mental illness, including those in the healthcare profession. SEARHC Behavioral Health will use the following evidence-based strategies: - ASAM criteria - Motivational Interviewing/Motivational Enhancement - Trauma-Focused Cognitive Behavioral Therapy - Matrix Model - Telehealth Provision of Services - Alaska Screening Tool - Client Status Review - Integrated Assessment - Client-Centered Treatment Planning - Comprehensive Community Support Services - Crisis Intervention - Crisis Stabilization - 24-hour Mobile Crisis Response Team