CT Discretionary Funding Fiscal Year 2023

Thanks to a new 5-year federal grant, CHR is collaborating with a network of community partners to help address unmet mental health needs across Hartford, Tolland and Windham Counties. The project, named Operation Green Ribbon, will provide Mental Health First Aid (MHFA) training to social and human service staff; criminal justice professionals; veterans, armed services members and their families; K-12 teachers and school personnel; as well as community college students and faculty. The population to be served includes individuals of all ages who reside in the 50-town catchment area and are experiencing undiagnosed mental health needs. The first goal is to develop a network of trainees to identify, support, and refer children and adults who are faced with mental disorders to appropriate resources. Objective 1: By the 4th month of the grant, CHR's Instructors will be certified in MHFA. Objective 2: By the end of year 1, the Instructors will train a minimum of 12 social service staff followed by an additional 12 each year until the end of the grant. Objective 3: By the end of year 1, the Instructors will provide MHFA training that will include crisis de-escalation techniques to 12 Criminal Justice Professionals and will train 12 more each year until the end of the grant. Objective 4: By the end of year 1, the Instructors will provide Youth MHFA to 18 personnel from k-12 schools and will train an additional 18 each year until the end of the grant. Objective 5: By the end of year 2, the Instructors will train 6 community college employees in MHFA and will train and additional 6 in each year until the end of the grant. Objective 6: By the end of year 2, the Instructors will train 10 armed services personnel, veterans, and/or their families in MHFA for Veterans, including crisis de-escalation techniques and will train an additional 8 individuals during each of the three years remaining in the grant. The second goal is to increase trainees' understanding of community resources. Objectives include developing a Mental Health Awareness Training Plan, reviewing the plan with CHR's Consumer/Family Advisory Committee and developing a Mental Heath Awareness Resource Manual. Each MHFA trainee will receive written and electronic versions of the manual that identifies professional services, self-help and peer support opportunities, and other resource options by the 8th month of the grant. The manual will also be made available electronically by the end of the first year of the grant on CHR's website and Facebook page, and through links to the manual on willing provider and agency websites. In all, 300 people will be trained, representing 60 people over 5 years.

Suicide is the second leading cause of death for youth starting at the age of 10. It is critical that we have a force of individuals trained to detect and screen for potential suicide risk. This project, Training to Establish an Alliance Centered on Hope (TEACH), aims to establish a core group of 60 trainers in Question-Persuade-Refer (QPR), train at least 9600 adolescents and adults in QPR, and to introduce those trained to evidence-based clinical screening tools such as the ASQ in an effort to fill a critical gap in our ability to intervene before a suicide death. TEACH is a continuation of the work done at Connecticut Children's initially in our Emergency Department. Connecticut Children's began universal suicide risk screening for all emergency department patients 10 years of age or older in August of 2019. We prepared staff by providing QPR training with an introduction to the ASQ screener. In twelve months, the emergency department screened over 17,000 patients. Connecticut Children's nursing and provider staff achieved greater than 90% compliance rate with the screening process. We identified 16% of patients screened positive for suicide risk on the ASQ. Nearly a third of those screening as at-risk (5% of all screened patients) presented to the emergency department with medical chief complaint (e.g., cough, fever, abdominal pain), rather than a behavioral complaint. Families were highly compliant with screening protocols, with fewer than 20 parents refusing to have their child screened. Despite concerns about screening children under 12 years old, 135 10-year olds screened positive for suicide risk. This preliminary work shows that training in QPR, and the use of the ASQ, are of critical importance in saving the lives of youth. As such, we plan to expand this critical work by training: (1) healthcare professionals and staff throughout our institution including our inpatient and ambulatory care settings (2) individuals involved with the care and education of youth (3) adolescents in our community. To reflect the community we serve, we will select 25% of our trainees to be bilingual in Spanish and English. We will recruit individuals interested in TEACH by marketing within Connecticut Children's and within our community partnerships utilizing flyers, social media campaigns and our hospital website. Our outcomes include training 60 trainers in QPR; 20 in each of the first three years of the grant. We will train 9600 healthcare providers, adult caretakers/educators, and adolescents in our community at the conclusion of the five years (annually: 800, 1600, 2400, 2400, 2400). We plan for 15 of the trainers and 2,400 of those trained to be bilingual in Spanish and English. In addition to meeting our training numbers, our additional evaluative measures of success include (1) increased confidence and comfort with QPR and evidence based screening tools by conducting pre/post class evaluations to trainees (immediate evaluation); (2) continued application in the use of QPR and validated screening tools by surveys that will be sent to trainees monthly in the first three months after training (short term evaluation); and (3) monthly text messages for two years after training assessing how often they used QPR in the last 30 days (long term evaluation).

Connecticut has one lead NSPL provider, the United Way of Connecticut (UWC)/2-1-1, which also serves as the mobile crisis call center hub for the lifespan. At this time, UWC provides 24/7 call center services for the CT NSPL callers, but no text or chat services. However, UWC does utilize text and chat for information and referral (I&R) services which will help to inform the 988 planning to add these services for CT NSPL callers. Similar to other states across the country, Connecticut has been experiencing significant challenges with hiring and retaining staff across all agencies, programs and levels of care. This staffing shortage has also had a direct impact on UWC. There is concern about the current answer rates, which are believed to be impacted by the limited staffing. Additional staffing will be needed to meet the increase in call volume with the implementation of 988. This funding will be used by the UWC to subcontract with a vendor to be a back-up call center in order to be better equipped to meet the call demand and improve in-state answer rates.

The Connecticut Partnerships for Hope and Healing (PH2) application proposes to enhance statewide and community-level mental health promotion and suicide prevention, intervention and response capacity and readiness to utilize comprehensive, equitable, public health approaches and evidence-based practices, frameworks and strategies (EBPs) to address gaps and reduce suicide attempts and deaths among youth age 24 and under. Planned enhancements include a Training Collaborative, Data Dashboard, 988 Suicide and Crisis Lifeline co-promotion with the state's suicide prevention campaign, release of CT's Suicide Prevention Plan 2030, development of informed, coordinated, and sustainable partnerships within five prioritized catchment areas across schools, campuses, community organizations and clinical services to ensure at-risk youth are identified, connected to care/treatment, provided with lethal means counseling, safety planning, and follow-up services. The PH2 will promote suicide prevention as a core priority in CT, and will utilize interventions that are data and quality-driven, sustainable, culturally competent and equitable, formalized, uniform, and accountable with the capacity and readiness to provide services in an organized and timely fashion. The CT Departments of Mental Health and Addiction Services, Children and Families, and Public Health, with CT Suicide Advisory Board (CTSAB) guidance, will co-direct the PH2 and partner with the United Way of CT/211, the 988 Suicide and Crisis Lifeline provider and statewide mobile crisis call center, for the PH2 management and implementation, and UCONN Health for the PH2 evaluation. The PH2 will serve an estimated, unduplicated count of 2,000 annually and 10,000 over five years of diverse youth age 24 and under associated with education settings once services begin, and will train and educate an estimated, unduplicated count of 1,000 annually and 5,000 over five years of supportive adults in educations settings, families, juvenile justice systems, substance use and mental health services, child protection and foster care, and other youth and young adult-serving organizations. PH2 goals and objectives are aligned with the National Strategy for Suicide Prevention and CT's Suicide Prevention Plan 2025, and ensures that the PH2 will inform CT's Suicide Prevention Plan 2030. The PH2 will utilize multiple EBPs, including, but not limited to the: CDC's Preventing Suicide Technical Package; SAMHSA's Strategic Prevention Framework; Zero Suicide Institute's approach and EBPs; Suicide Prevention Resource Center's Comprehensive Model for Suicide Prevention and Mental Health Promotion, and the EDC's Multi-Tiered System of Supports for Suicide Prevention. The PH2 will build on current CT suicide and substance use disorder prevention infrastructure, resources, coalitions, services, and strategies; experience gained from three prior CT GLS State Youth Suicide grants; strong relationships and partnerships within the CTSAB; and other federal and state-funded initiatives with shared missions, goals and objectives, including Tribal. Youth, their families, and persons with lived experience will have opportunities for direct input through PH2 strategies and activities to assure unique needs are identified and met. Baseline measures will be established, and PH2 efforts will be closely monitored and evaluated for continuous quality improvement to accomplish goals and objectives, and maximize statewide impact and sustainment.

Health Education Center (HEC) proposes to provide mental health awareness and intervention training for three groups of gatekeeper groups that deal directly with the population of focus: persons experiencing serious mental illness (SMI) or serious emotional disturbance (SED). In Connecticut, more than three times as many people died by suicide in 2017 than in alcohol related motor vehicle accidents. Suicide was the 2nd leading cause of death among those ages 15-34, 4th leading cause of death for ages 35-54, and 8th leading cause of death for ages 55-64. Overall, suicide is the 12th leading cause of death in Connecticut. Native Americans and veterans are at higher risk of suicide. HEC and its partner, Southwestern AHEC, will train community gatekeepers (Community Health Workers, Medical Interpreters, Tribal community members, including veterans, health professions students and a statewide network of community volunteers and providers working on trauma prevention and healing in Connecticut’s most economically distressed areas) in suicide prevention and intervention methods. Training for suicide awareness and intervention will be delivered by using two evidenced-based practices, Applied Suicide Intervention Training (ASIST) curriculum and the QPR (Question, Persuade, Refer) Gatekeeper Training for Suicide Prevention (QPR). Training will teach individuals to recognize the signs and symptoms of mental illness and how to appropriately and safely respond. Our training populations are uniquely positioned as gatekeepers, both within their peer communities and the general public, making them more likely to encounter persons at risk of suicide. The geographic catchment area is Connecticut. Over the course of the five-year project, HEC will train 352 gatekeepers in ASIST and 1,000 gatekeepers in QPR. Gatekeepers are individuals who are trusted and in a position to outreach to and educate members of their communities. An estimated 300 interventions will be performed over the project period and 150 referrals will be made for mental health services for each of the Suicide Intervention Methods.