CO Discretionary Funding Fiscal Year 2018

The purpose of the proposed Project Bridge is to bring a high quality of services for trauma treatment to the underserved population of children of refugee and immigrant families.
The core strategy is to create a safe, culturally-sensitive, linguistically accessible and trauma-informed system of care that includes effective evidence-based treatment interventions. Project Bridge plans to develop a systematic engagement, screening, assessment, treatment and recovery process that takes into account cultural and linguistic needs.

The population of focus for Project Bridge is refugees and immigrants who have resettled in Aurora, Colorado. According to the most recent Colorado Department of Public Health and the Environment (CDPHE) Surveillance Report about 2,000 refugees and asylum seekers come into Colorado annually, with most of them settling in Aurora, the geographic area for Project Bridge.

By targeting immigrant and refugee children specifically, Project Bridge's population includes those that are most vulnerable to social, economic and health inequities. These communities experience insecure and difficult socioeconomic conditions, including poor housing, unstable employment, acculturation issues, insufficient income and limited access to transportation and benefits. These health disparities are exacerbated by language and cultural barriers. The services and methods described in this project are responsive to the diverse linguistic and cultural needs of our unique population. The providers include those that come from the cultures we serve and our partner agencies are specifically designed to serve immigrant and refugee groups and base all of their service provision on providing culturally and linguistically relevant services.

Colorado Coalition for the Homeless (CCH) ACT Project proposes to expand and maintain ACT services for people with serious mental illness (SMI) who are currently experiencing or have formerly experienced chronic homelessness. A metro Denver geographic catchment area is proposed, including Denver, Adams, Arapahoe, Boulder, Broomfield, Douglas, and Jefferson counties. CCH anticipates that 100 people will be served by the proposed project at any given time and up to 150 people will be served over the full 5-year project duration. CCH will utilize the proposed project to establish a level of care continuum across its supportive housing programs. The proposed ACT team will provide the highest level of CCH delivered care. CCH will expand one of its existing modified ACT teams by adding a full-time psychiatrist and a second full-time nurse. These staffing additions will result in the creation and maintenance of one high fidelity ACT team at CCH. A mechanism is in place to ensure and evaluate high fidelity to the ACT model. A level of care assessment and a comprehensive psychosocial assessment using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) will ensure all participants served by the proposed ACT team are experiencing or have experienced chronic homelessness and are also diagnosed with a SMI. The following measurable objectives will assess project success: • Improvement in participants’ overall level of function, as measured using the Daily Living Activities 20 (DLA-20), from the average baseline score to a to-be-determined average target score by the end of the grant term; • Decrease in negative impacts of substance use on daily living, as measured using the DLA-20, from the average baseline score to a to-be-determined average target score by the end of the grant term; • Decrease in hospitalizations, as measured using the Colorado Health Information Exchange, from an average baseline monthly hospitalization rate per 100 ACT participants to a to-be-determined target rate by the end of the grant term; • Improvement in housing stability, as measured using the DLA-20, from the average baseline score to a to-be-determined average target score by the end of the grant term; • Decrease in interactions with the criminal justice system, as measured using the DLA-20, from the average baseline score to a to-be-determined average target score by the end of the grant term; and • Increased fidelity to the ACT model, as measured by SAMHSA and State of Colorado fidelity assessments from 75.2% to 100% by the end of the grant term.

Expanding The Colorado Mental Wellness Network’s Statewide Recovery Support Services Project proposes to reach Coloradans with mental health and/or substance use disorders with tools and support for recovery. According to the most recent census the total population in the state of Colorado is 5,684,203; the number of people suffering from some form of mental health issue is approximately 1,591,576 around 28%. Colorado is comprised of 68.6% Caucasian, 21.3% Hispanic/Latino, 4.5% African American, 3.3% Asian, 2.3% “other”, and 0.6% American Indian and Alaska Native. Eighty six percent of the community speaks English, 8% know English and a second language very well, and 12% know English and a second language [2]. The Network plans to target underserved populations through its collaborative partnerships and advisory groups throughout Colorado. Over the course of the three year grant approximately 1000 individuals (an estimated 333+ annually) will receive training for employment, tools for wellness, and support from peers for leadership development and empowerment. Many more individuals (approximately 1,750 people annually or 5,250 total) throughout Colorado will benefit from the advocacy work and representation The Network will provide on behalf of people with behavioral health conditions, which include both mental health conditions and substance use disorders, and those with dual diagnoses. The primary goals that fulfill the mission of the organization is to expand and enhance our current projects: 1) Individuals will be empowered to improve their overall health and wellness through action planning and self-care tools utilizing skills developed through: Wellness Recovery Action Plan (WRAP) and Wellness and Recovery Support Groups. Improving quality of and access to statewide peer support and recovery-oriented, integrated and coordinated treatment, services and supports. 2): Expand statewide consumer leadership to improve community perceptions of mental illness through advocacy efforts and collaboration within consumer-operated organizations and in the community primarily through: the Colorado Leadership Academy (CLA) and Advocacy Team Efforts. 3) Recovery-oriented integrated treatment will be promoted through a trauma-informed peer recovery coach workforce through: The Network’s Peer Recovery Coach Certification Training and quarterly support meetings through the Colorado Chapter of iNAPS to build capacity and sustainability of statewide consumer networks.

Colorado Project AWARE aims to build the state and local infrastructure and capacity for a comprehensive school behavioral health services system that supports every student in Colorado in reaching their fullest potential in school and life. Colorado is eager to seize the opportunity with the increased public awareness of the dire impact of unaddressed behavioral health needs to coordinate and enhance resources across systems to promote students' mental wellbeing and prevent behavioral health issues. The Colorado Department of Education (CDE) has identified three local education agencies with unique contexts and populations to partner with in building a locally driven system for the state: Aurora Public Schools (APS), Fountain-Fort Carson School District (FFCSD), and Thompson School District. The AWARE goals include: 1) building state infrastructure and capacity through partnerships, policy, shared data coordinating resources and intensive coaching for data-driven decision making; 2) building LEA infrastructure and capacity through partnerships, policy, shared data systems, coordinating resources and intensive systems coaching for data-driven decision making; 3) utilizing implementation science to deliver research-based programs and strategies to build students' social, emotional and behavioral wellbeing while reducing behavioral health risks; 4) increasing awareness of behavioral health issues, reducing the stigma and increasing behavioral health promotion; and 5) securing sustainable funding mechanisms for comprehensive school behavioral health services.

Colorado Project LAUNCH (COPL) promotes the wellness of young children from birth to age eight by addressing the physical, social, emotional, cognitive, and behavioral aspects of their development. COPL will improve outcomes for children birth to age eight by applying the knowledge and experience of Project LAUNCH in Weld County to inform efforts in Adams County and statewide to improve coordination of key child-serving systems and the integration of behavioral and physical health services. The long term project goal is that Colorado systems are sustainable and effective in ensuring families with young children have equitable access to quality services and highly skilled early childhood professionals in support of the state vision that all children are valued, healthy and thriving (Early Childhood Colorado Framework).

Colorado has successfully implemented systems of care in 12 Communities of Excellence across the state with the COACT Colorado: Strong Minds, Strong Futures initiative. All of these communities, which include 15 counties, are serving children and youth with serious behavioral health challenges and their families using family advocates and high-fidelity wraparound Colorado has also made progress in developing a system of care infrastructure by building on partnerships of the Collaborative Management Program and working with the Colorado Department of Health Care Policy and Financing (HCPF). HCPF is considering the inclusion of a system of care service package in the new RFP procurement for Regional Care Collaboratives and Behavioral Health Organizations to begin in July 2018. Colorado's target population for system of care efforts has been children and youth SED who are involved in other systems and are in or at risk of out of home placement. This proposal includes expanding the service array for two sub-populations within this broader target population who present additional challenges: 1) children and youth with a dual diagnosis of mental health and intellectual or developmental disability, including autism, and 2) transition age youth ages 14-21. This proposal includes assessing the service array with the lens of these two sub-populations and working to increase effective, evidence-based, community services to better serve these children and youth and their families.

CO Connecting Youth Networks of Care

Zero Suicide Colorado will reduce the burden of suicide among Colorado adults ages 25+ by promoting suicide prevention as a core component of healthcare and increasing effective clinical and professional strategies for assessing and treating those at risk for suicide. Statewide efforts include implementing the Zero Suicide framework in health settings. The Office of Suicide Prevention will infuse saturated efforts within five higher burden counties in the state. Within Denver, El Paso, Larimer, Mesa and Pueblo counties, Zero Suicide Colorado will work collaboratively with community mental health centers and health systems within five key counties of the state to implement all elements of Zero Suicide. The project will include training for both clinical and non-clinical staff, establishment of embedded screening and assessment protocols, and the development of robust suicide care management plans for clients at risk for suicide. Zero Suicide Colorado will also include telephonic follow-up services for suicidal individuals post-discharge from emergency and inpatient settings. Zero Suicide Colorado will streamline and coordinate existing implementation of the Zero Suicide framework, including a rollout of shared metrics across sites to more timely measure system changes as well as outcomes related to suicide attempts and suicide deaths within participating health sectors. The funding will allow Colorado to move from planning and pilot stages to full implementation, giving special attention to veterans not connected with Veterans Administration Health services. Zero Suicide Colorado will accomplish the following goals during the five-year project: Goal 1: Reduce the suicide death rate among adults age 25 and older in Colorado from 25 deaths per 100,000 residents in 2015 to 19 by 9/29/22. Goal 2: Reduce the suicide attempt hospitalization rates among adults age 25 and older in Colorado from 51.9 suicide attempt hospitalizations per 100,000 residents in 2015 to 45 by 9/29/22. Goal 3: Reduce the suicide attempt emergency department visit rates among adults age 25 and older in Colorado from 74.5 suicide attempt emergency department visits per 100,000 residents in 2015 to 65 by 9/29/22. The OSP will conduct process, outcome, and performance evaluations throughout the cooperative agreement, and will contract with evaluation partners at the University of Colorado, School of Public Health and Injury Control Research Center -Suicide Prevention at the University of Rochester to design and implement evaluation tools for the life of the project.

DenverStrong: Building Resilience and Ending Stigma through Education will train individuals to recognize the signs and symptoms of mental disorders, teach them crisis de-escalation techniques and educate them about mental health providers so they can refer individuals to appropriate services. The Denver Department of Public Health and Environment (DDPHE) and its partners, Denver Public Health (DPH), a department of the Denver Health and Hospital Authority; and Denver Human Services’ Child Welfare Division, Prevention Services, will train 1,000 individuals each year (3,000 over the project period). Those targeted for training include first responders; healthcare providers and lay staff who work in Denver’s safety-net hospital; veterans and veteran service providers; city employees; educators; community and faith-based leaders; recreation center staff; and child welfare-affiliated families and providers of childcare services and foster and kinship care. These categories of individuals were selected because they are likely to interact with people who are experiencing a mental health disorder. Residents of Denver are the population of focus because in 2017, 76,088 Denver County residents age 5 and older (12.3% of the city’s population) indicated that they had poor mental health. Among those people, 64,591 indicated that they needed mental health care but did not get it during the past 12 months.[1] DenverStrong’s partners include two licensed and experienced mental health providers who will accept referrals from individuals who receive mental health awareness training: the Mental Health Center of Denver and DPH’s Outpatient Behavioral Health Services. DDPHE has selected the following evidence-based practices (EBPs) to train people to better meet the needs of individuals with mental health disorders: Mental Health First Aid; Youth Mental Health First Aid; Crisis Intervention Training (CIT); Question, Persuade, Refer (QPR); Wellness Recovery Action Plan (WRAP); Bringing the Protective Factors Framework to Life in Your Work; peer mentoring; and trauma-informed practices training and follow-up consultation. DenverStrong’s goals are to 1) increase trainees’ ability to recognize the signs and symptoms of mental health disorders among adolescents and adults and 2) increase trainees’ ability to engage effectively by assessing an individual’s mental health status and intervene effectively by providing resources and referrals to mental health services, when appropriate. The objectives are: 1) By September 30, 2021, 3,000 Denver residents will be trained in at least one of the selected EBPs; 2) By September 30, 2021, 80% of trainees will increase their intervention effectiveness scores; 3) By September 30, 2021, the number of referrals made to mental health services by trainees will increase by 70%; and 4) By September 30, 2021, 80% of trainees will have increased awareness of the signs of mental disorders and available resources. [1] Colorado Health Institute. (2018). Colorado’s new normal: Findings from the 2017 Colorado Health Access Survey.

The Colorado Children's Congregate Care Resiliency Opportunity Project (CROP) implements an innovative trauma-informed resiliency-based collaborative model designed to prevent and reduce congregate care placements for children in child welfare/juvenile justice. Seven Colorado Department of Human Services Child Welfare offices have partnered together to expand their current trauma-informed system efforts to develop and employ new approaches to identify, assess, and intervene with their most vulnerable, yet most challenging children.

CROP Prevention Model objectives will screen children and their caregivers for trauma, provide comprehensive neurodevelopmental trauma assessments screening positive for trauma, and develop resiliency-based case planning based on the assessment findings. Resiliency-based strategies, built upon developing relatedness, mastery, and affect regulation skills for children/caregivers will then be implemented through intensive in-home coaching programs to stabilize placements.

Simultaneously, children will receive Trauma Focused Cognitive Behavioral Therapy, while caregivers will receive evidence-based community-based trauma treatments. To empower caseworkers, congregate care staff, and clinicians with increased trauma knowledge and resiliency strategies National Child Traumatic Stress Products will be implemented including "Think Trauma," "Road to Recovery" and "Resource Parent Curriculum". During YEAR I approximately 264 children will be served followed by at least 100 each of the following five years. CROP, to sustain a resilient workforce, will provide ongoing secondary traumatic stress processing and strategies through the utilization of the NCTSN Resilience Alliance Curriculum. Evaluation will focus on the effectiveness of the model through quantitative analysis of CROP goals of prevention, reduction, length of stay, recidivism, and improvement in well-being for children at risk of entering, or currently in, congregate care.