AL Discretionary Funding Fiscal Year 2020

Project Title: Promoting Integration of Primary and Behavioral Health Care Description: Integrating primary care services into behavioral health for adults with serious mental illness and children with serious emotional disturbance through a Community Mental Health Center that is also a Federally Qualified Health Center. Population of Focus: The populations of focus for this project are children and adolescents with serious emotional disturbance and adults with serious mental illness with physical health comorbidities. Individuals will be enrolled in AltaPointe Health Systems, Inc. (AHS) programs in Mobile, Alabama that serve these populations, Childrens Outpatient Program (COP) and Zeigler Adult Outpatient Program (ZOP). COP serves children and teens ages 3-19 with emotional and behavioral needs, and ZOP is AHSs hub for individuals with severe mental illness who reside in AHSs housing continuum. In the COP, 91% are insured through Medicaid, 3.7% insured commercially, and 4.9% indigent. African-Americans are the largest race served, making up nearly 49% of the patients with 45% being Caucasian. Just under 5% of the patients identify as Hispanic. ZOP serves a patient population with similar racial and payor breakdowns as the child patients served by COP. Goal 1: Promote full integration and collaboration in clinical practice between primary and behavioral healthcare. Objective A: AHS will provide integrated primary care and behavioral health services to 2500 adults with serious mental health or children with serious emotional disturbance in Year 1 and 4000 annually thereafter, for a total of 6,700 patients over five years. Objective B: Department of Mental Health (DMH) will develop a workgroup to identify policy solution(s) to capture the bundled community mental health center (CMHC) services delivered under the AHS FQHC to address the complexity of the funding environment. Goal 2: Support the improvement of integrated care models for primary care and behavioral health care to improve the overall wellness and physical health status within the population of focus. Objective A: AHS shall integrate patient centered primary care services into the Zeigler Campus Adult Outpatient Program and the Childrens Outpatient Program within four months of funding. Objective B: AHS shall secure Joint Commission Patient Centered Medical Home recognition for both sites within one year of funding. Goal 3: Promote and offer integrated care services. Objective A: AHS will screen (and treat as needed) all patients within the population of focus for depression and substance use disorder by the end of Year 1. Objective B: AHS will implement screening protocols during Year 1 (and treat/refer as needed) for all clients for the presence of co-occurring chronic physical conditions including HIV, Hepatitis, and tuberculosis. Objective C: AHS will implement chronic disease and prevention protocols and clinical performance measures by the end of Year 1.

Abstract The Greater Mobile Assisted Outpatient Treatment Program (GMAOT) was designed by AltaPointe Health to address the growing number of involuntary commitments, increased number of individuals with serious mental illness in Mobile Metro Jail, and a large number of homeless individuals in the community living with mental illness. The program will provide increased support and services to at least 140 adults with a serious mental illness per year in Mobile County, Alabama. The target population is individuals with a history of multiple involuntary psychiatric hospitalizations, frequent encounters with law enforcement, including arrests, limited social support, limited insight into their diagnosis, homelessness, poor physical healthcare access, and a history of failed treatment compliance with traditional outpatient services. The Mobile County Probate Court Judge, working in conjunction with AltaPointe Health, is committed to finding a solution to enhance outcomes and quality of life for individuals living with mental illness in Mobile County. Individuals enrolled in the GMAOT program will have a designated treatment team closely monitoring treatment compliance with their court order, providing extended service delivery hours, utilizing existing services such as the Assertive Community Treatment (ACT) Team and Intensive Day Treatment, providing diagnosis and medication education, teaching daily living skills, and linking them to community resources and supports. The addition of a court of order for outpatient treatment will be used only as the least restrictive option. The goals of the AOT program are to 1) Reduce the incidence and duration of psychiatric hospitalizations by delivery of multi-disciplinary in-home services from the AOT Team multiple times per week, depending on need. 2) Reduce the interactions with the criminal justice system and maintain treatment within the least restrictive environment through monitoring treatment compliance and providing psycho-education. 3) Reduce the incidence of homelessness for individuals with a serious mental illness by linking participants to supportive housing services and resources needed to sustain community living. 4.) Improve access and compliance with healthcare assisting participants in obtaining healthcare benefits and linking them to an affordable local healthcare provider. 5.) Improve social outcomes for all participants by providing education, family support, and linkage to community resources. Qualitative and quantitative data will be collected, for the 12 months prior to enrollment, throughout enrollment, and for 12 months following enrollment, in order to measure outcomes and program effectiveness. Evidence-based practices such as AOT, ACT, Motivational Interviewing, and Trauma-Informed Care will be utilized to insure the highest quality of service delivery. Evidence-based Quality Improvement (EBQI) will provide timely feedback to make adjustments in real-time to maintain program fidelity.

Fewer than half of 7.9 million adults with a serious mental illness (SMI) or serious emotional disturbance (SED) receive treatment in the United States. These individuals are involved in one out of every five police calls, occupy 20% of the beds in America's prisons, and are the victims of over one quarter of fatal police shootings in the nation. The high level of interaction between law enforcement officers (LEOs) and individuals with SMI and SED is particularly pronounced in the State of Alabama, where fewer than 12.3% of these individuals receive treatment. Though evidence-based mental health awareness training (MHAT) models exist, implementation is lacking, particularly for LEOs in Alabama. In this project, we propose to develop a mobile Mental Health Education, Awareness, and Learning (mHEAL) program, an 8-hour online MHAT training course for LEOs, which will increase LEOs' mental health awareness and efficacy with de-escalation techniques while simultaneously decreasing stigma associated with mental illness. We will target 405 LEOs in Tuscaloosa County, Alabama, to provide the mHEAL training program. The proposed project will have two phases: (1) the development of the mHEAL training program and (2) the implementation of the program in Tuscaloosa County. Throughout the project, we will use the principles of a community-based participatory research approach and the Consolidated Framework for Implementation Research framework to develop, implement, and disseminate the mHEAL program. We will use two evidence-based mental health practice models, Mental Health First Aid and Crisis Intervention Training, to develop the program. The two models will be combined and tailored into a single 8-hour online training program for LEOs. Content will include detailed mental health information and wellness programming that will help LEOs serve specific at-risk populations, including veterans who suffer from SMI or SED. We will also create an awareness campaign using social and print media to draw attention to the significance of MHAT and to motivate LEOs to participate in the mHEAL training program. By working with the police chiefs in Tuscaloosa County, the program will be implemented in all nine police departments in the county. LEOs will volunteer to participate in the program, which will be completed at their own pace. Data will be collected at three time points, pre-, post-, and 6-month follow-up tests, to assess the program's efficacy and feasibility. Should the mHEAL training program prove to be successful, we will work with law enforcement partners to disseminate and sustain the program statewide to reduce mental health training disparities for LEOs in Alabama.

The purpose of this project, Alabaster For Tomorrow's Drug Free Communities Support Grant, is to prevent youth substance use in the City of Alabaster targeting youth in grades 6-12. The Coalition serves Alabaster, Alabama, a community of 32,567. The goals of the coalition are to establish and strengthen community collaboration in support of local efforts to prevent youth substance use. The coalition will achieve its goals by implementing these strategies: Providing information to increase awareness of the coalition and to recruit new members; strengthen the skills of the Thompson High School Peer Helpers to enhance protective factors in students at the middle and high school level; provide information and awareness regarding the risk of marijuana and alcohol use; provide support for at-risk youth with needed resources; enhance the skills of parents to discuss the dangers of underage alcohol and marijuana use; and reduce the availability of alcohol and drug paraphernalia to youth in the City of Alabaster.

Drug Free Andalusia

The Children's Policy Council of Dallas County, Alabama Inc. (DCCPC) and its Drug Free Communities Coalition through the STOP (Sober Truth on Preventing Underage Drinking Act Grant) will implement a program to prevent and reduce alcohol use among youth and young adults ages 12-20 in communities through out Dallas County Alabama. Services to be provided: Goal one of the grant is to Increase Community Collaboration. DCCPC will utilize the following strategies: - Engage current members to establish an Alcohol Response Team to facilitate sharing information about efforts to address underage alcohol access - Provide information to increase awareness of the coalition's underage alcohol use prevention strategies and seek improvements through Town Hall Meetings Goal two of the grant is to Reduce Youth Substance Use. DCCPC will focus on reducing youth alcohol use and will utilize the following strategies: - Provide information about Alabama's Open House Party Law to adults in Dallas County - Enhance skills of parents to develop a parent network committed to not providing alcohol to youth in their homes - Provide support by hosting drug-free alternative activities for high school students and family friendly community events - Reduce access to alcohol by providing alcohol bottle locks and cabinet locks to encourage parents to lock up alcohol - Change consequences by training law enforcement on proper party dispersal methods - Change physical design by conducting a sticker shock campaign targeting prom and graduation seasons - Change/modify policy by adding information on the Alabama Open House Party Law to registration materials for both school systems Coordination planned with the appropriate state or local health agencies: Cahaba Mental Health is a member of the Dallas County Children's Policy Council and has a representative attend meetings. They are our local health agency liaison between the coalition's work and state health agencies.

The Council on Substance Abuse-NCADD (COSA-NCADD) will implement the Sekou Project. The project will have a priority focus on African American and other minority youth and young adults from the target population who also identify as MSM (men who have sex with men). The project will place navigators at two HBCUs within the city as well as work with three other colleges in the area. The goal of the project is to “reduce the incidence of substance abuse rates among African American and other minority college age males (ages 17-25), with a special emphasis on the MSM population during a 5-year period in Montgomery, AL”. The project objectives are: 1.1 Partner with local substance abuse, mental health and HIV/AIDS providers, and representatives from education, social service and student organizations to address substance use, living with HIV (including disease management), mental health, and trauma through system of care and case coordination services. 1.2 Provide environmental strategy to increase awareness and knowledge on substance abuse and risk behaviors reaching 10,000 African American and other minority college age males annually. 1.3 Provide screening and testing opportunities for HIV and viral hepatitis for 350 individuals in the community. 1.4 Provide culturally appropriate evidence-based prevention navigation services to 350 African American and other minority college age males. 1.5 Provide quarterly training on topics (i.e. substance use disorder prevention, treatment and recovery; HIV screening and clinical care needs of individuals infected with HIV) to 40 professionals representing college campus departments, social service, healthcare and other community providers on an annual basis. COSA-NCADD will partner with Medical Advocacy and Outreach (MAO) to implement the testing for HIV/HCV and will contract with Dr. D. Bogie for evaluation services.

Summary of Project: Addiction Prevention Coalition through assessing the needs of Birmingham, Alabama has planned interventions to reduce alcohol, marijuana and opioid misuse in the youth and adult populations and to build the capacity and infrastructure of the City of Birmingham’s systems and agencies to reduce substance use related issues. Population(s) to be Served: Demographics/Clinical Characteristics: Population 209,880; 53.8% female, 46.2% male; 27.0% white; 67.5% black or African-American; 0.2% American Indian/Alaska Native; 0.1% Native Hawaiian/Other Pacific Islander; 1.4% Asian; 1.9% two or more races; and 4.8% Hispanic or Latino;27.2% of people live in poverty Project Goals/Measurable Objectives/Strategies/Interventions: (Reach Total Population) Goal One: Strengthen prevention capacity and infrastructure in the City of Birmingham, AL; Objective 1:By August 29, 2025, APC will have hosted 18 Partnerships for Success subcommittee meetings; Objective 2:By August 29, 2025, APC will have disseminated 48 prevention messaging campaigns in the City of Birmingham; Objective 3:By August 29, 2025, APC will have conducted 4 Strategic Prevention Framework trainings to increase prevention capacity in Birmingham; Objective 4:By August 29, 2025, the Partnerships for Success subcommittee will have conducted quarterly Lunch and Learns to train 300 medical providers from UAB, Brookwood and Princeton Goal Two: Prevent the onset of substance use among youth in the City of Birmingham, AL; Objective 1:By August 29, 2025, APC will have conducted Positive Actions Curriculum classes for 4th grade students in 8 Birmingham City elementary schools; Objective 2:By August 29, 2025, Birmingham City Schools will operate 3 high school InFocus Chapters to prevent alcohol and marijuana use; Objective 3:By August 29, 2025, Birmingham City Schools’ early intervention program will reach 100% of first-time offenders with support services to reduce incidents in schools; Objective 4:By August 29, 2025, APC will have conducted 4 Parents of Addicted Loved Ones groups in the City of Birmingham, Alabama Goal Three: Reduce the progression of substance misuse and its related problems among adults in the City of Birmingham, AL; Objective 1:By August 29, 2025, APC, Birmingham Southern College, Lawson State Community College and UAB will have hosted 4 Sober Tailgates on-campus and at the Magic City Classic; Objective 2:By August 29, 2025, APC will have added 30 convenience stores to the Family Friendly Vendor Program; Objective 3:By August 29, 2025, Birmingham Police Department will have conducted quarterly Roadside Sobriety Checkpoints; Objective 4:By August 29, 2025, APC will have trained 10 facilitators to conduct the Prevention Partners program in churches and workplaces; Objective 5:By August 29, 2025, UAB Beacon Recovery Program will have reached 100 at-risk youth with evidence-informed interventions.

The purpose of this project is to prevent youth substance use targeting youth in grades 6-12 in the City of Montevallo. The coalition serves Montevallo, Alabama, a community of 6,626. The goals of the coalition are to establish and strengthen community collaboration in support of local efforts to prevent youth substance use. The coalition will achieve its goals by implementing these strategies: Providing information to increase awareness of the coalition and to recruit new members; strengthen the skills of the Montevallo Middle School Peer Helpers to enhance protective factors in students; provide information and awareness regarding the risk of marijuana and alcohol use; provide support through partnering with the Montevallo Junior City Council to host drug-free social events; enhance the skills of parents to discuss the dangers of underage alcohol and marijuana use; and reduce the availability of alcohol and drug paraphernalia to youth in the City of Montevallo.

Jefferson County, the county seat of Birmingham, Alabama, is in the top decile for HIV prevalence and incidence nationally, and African American (AA) youth are disproportionately affected. To respond to the HIV epidemic in Jefferson county, the University of Alabama at Birmingham (UAB) proposes to increase services for AA youth in Jefferson County with support from the Substance Abuse and HIV Prevention Navigator Program for Racial/Ethnic Minorities ages 13-24. The UAB team proposes Project LEAP (Linkage, Education, and Prevention), a goal-oriented approach to 1) expand access to substance use and HIV education for African American youth and their community, 2) increase HIV prevention services, and 3) integrate a Prevention Navigator who can link participants to substance use treatment and HIV services. In Jefferson County, 621 of every 100,000 residents have HIV. Of the 653 new HIV cases in Alabama in 2017, 146 were in Jefferson County. Of these, >50% occurred in persons < 30 years, and >65% were AA. By partnering with community organizations, the team proposes to promote Substance use prevention is HIV prevention; link youth to HIV, hepatitis C and substance use screening; and navigate them to services in order to reach the below goals: GOAL 1: Expand the capacity of community partners to provide substance use and HIV education GOAL 2: Promote Awareness of HIV Treatment and Prevention in persons who use substances GOAL 3: Increase utilization of HIV prevention services among Youth GOAL 4: Integrate a Prevention Navigator to increase linkage and coordination necessary for youth to obtain HIV and substance use treatment and prevention services GOAL 5: Increase retention in care among youth with HIV and substance use disorders The Project LEAP team will rely on a full-time Prevention Navigator who will be integrated within the community partner teams starting with the Addiction Prevention Coalition and expanding to UAB Adolescent Clinic, Beacon Recovery, and AIDS Alabama. In addition to educating youth, Project LEAP trainings and our awareness campaign will increase awareness among staff, providers, and families that substance use is an HIV risk factor. We will recruit Youth Prevention Champions to advise us and promote Project LEAP initiatives and messaging. We will develop an Advisory Board to meet quarterly, advise us on program initiatives, and review program progress. Our partners collaborate with and serve city schools, faith based communities, and criminal justice settings, which will allow our team to provide education and assessments of youth, staff and providers for the most vulnerable youth in our region. To insure the success of Project LEAP, our team includes clinician researchers with experience in HIV treatment and prevention and Addiction Medicine in addition to an experienced Program Evaluator. We will serve 500 students over the 5-year project starting with 50 in year, increasing to 100 annually in years 2 through 4, and 150 annually in year 5.