FL Discretionary Funding Fiscal Year 2018

Apalachee Center, Inc., a community mental health center serving the eight counties of florida's Big Bend region, proposes to integrate primary health care with the behavioral health care currently provided in its Gadsden County, Florida clinic. Gadsden County is rural, impoverished, and the only predominantly African American county in Florida. Health statistics for this County are regularly among the highest risk in the state. The goal of this innovative project is to reduce early mortality from preventable chronic and infectious conditions among people with Serious Mental Illness (SMI), through the provision of primary and preventive healthcare within their trusted behavioral health home. Consistent with the goals of this grant, this initiative focuses on full integration of primary care and behavioral health, expanding on lessons learned during the integration of these services in Apalachee Center's Leon County clinic. The anticipated benefits of this project include increased access to care, improved health outcomes, lower healthcare costs, and an expansion of the use of peers within the integrated health workforce. Specifically Apalachee will fully integrate a primary care team into the behavioral health clinic to address the preventable and treatable chronic and infectious diseases that dramatically reduce life expectancy for the outpatient population of persons with SMI, and provide a full service health home for Apalachee Center's clients in Gadsden County. Apalachee estimates that among the target population, approximately 150 clients would receive integrated services during the first year, 300 during the second year, 400 during the third year, and 500 within the final year of the grant.

The Aspire ACT Team Expansion & Enhancement Project will target adult males and females with Serious Mental Illness (SMI), who are 18 years of age or older and reside in Orange County, Florida. The project will provide evidence-based Assertive Community Treatment services and expand the capacity of Aspire’s existing ACT Team allowing it to serve an additional 50 adults with SMI. (This will increase the team’s active caseload from 100 to 150.) Based on a project 15% dropout rate, the project will serve 80 unduplicated adults with SMI over the 5-year life of the project. The ACT team is a self-contained, integrated, multi-disciplinary team that provides intensive community based treatment to adults at risk of hospitalization, homelessness and/or incarceration due to a mental health disorder and insufficient attention to their primary care needs. The team provides culturally competent services focused around the strengths and needs of each adult and his/her family and natural support systems. By increasing access, engagement, and retention in treatment services, the ACT Team improves health, behavioral health, and social outcomes for adults with SMI. The goals of the Aspire ACT Team Expansion & Enhancement Project are: 1.) Increase the unduplicated number of adults with SMI receiving evidence-based ACT services; 2.) Increase access, engagement, and retention in treatment services among adults with SMI; and 3.) Provide a full continuum of treatment and ancillary services to reduce rates of hospitalization, mortality, substance use, homelessness, and involvement with the criminal justice system among adults with SMI. The project’s measurable objectives include: 1.) 85% of individuals admitted into ACT services will remain actively engaged in treatment services for 12 months post admission; 2.) 80% of individuals enrolled in the program for at least 60 days will adhere to their medication schedule as prescribed by the ACT Treatment Team for 12 months post admission; 3.) 85% of individuals enrolled in the program for at least 60 days will increase abstinence from the use of alcohol and other drugs not appropriately prescribed as part of their ACT Individualized Treatment Plan; 4.) 85% of individuals enrolled in the program for at least 60 days, will demonstrate improved functioning and ability to perform self-care tasks as measured by the FARS and the DLA-20; 5.) 85% of individuals enrolled in the program for at least 60 days will remain in stable housing in the community for more than 12 months post admission; 6.) 75% of individuals enrolled in the program for at least 60 days will have no inpatient admissions or ER visits for 12 months post admission; 7.) 75% of individuals enrolled in the program for at least 60 days will have no arrests and spend no days incarcerated for 12 months post admission; 8.) 100% of individuals enrolled in the program for at least 30 days, will be linked to physical health services; and 9.) 100% of individuals enrolled in the program for at least 30 days, will be linked to appropriate educational and employment services.

Be Free Lake, Inc. proposes to address the behavioral health issues of Veterans, armed services members, their families, and the community for Lake and Sumter Counties. The goal of the Lake County MHAT Project is to build capacity in our community, to detect and respond appropriately to behavioral health concerns impacting adults and youth, and to connect them to needed services. Importantly, Be Free Lake, Inc. will work with agencies, families, law enforcement, and policy makers to increase mental health awareness and training opportunities for our local Veterans, armed services members, their families, and community members. The objectives of the Lake County MHAT Program are to: (1) train 1,530 veterans, armed services members and families, and community members to recognize the signs and symptoms of mental disorders including SMI and SED through Mental Health First Aid Training by September of 2021; (2) increase mental health awareness in Lake County by reaching 5,000 individuals monthly through mental health awareness trainings, social media, and activities by September of 2021; (3) provide all Lake County school personnel and community based mental health agencies with the resources (print and web based) to accurately refer individuals with the signs and symptoms of mental illness to appropriate services throughout the life of the project; (4) train 459 veteran service providers, law enforcement, first responders, and others (or 30% of the total amount trained) to identify persons with a mental disorder and employ crisis de-escalation techniques through MHFA training and referral to CIT when appropriate by September of 2021; (5) link 1,000 veterans, youth, and community members to mental, emotional, and behavioral health assistance and services as measured by referrals monthly by September of 2021; (6) increase coalition capacity to implement evidence based curriculum for MHAT to promote positive behavioral health by training 4 stakeholders/service providers as MHFA Instructors by September of 2019 (BFL currently has 10 trained MHFA Instructors to use on this project) ; (7) increase membership in the established interagency advisory and leadership workgroup as measured by adding 4 new collaborative partners for MHFA workgroup by December of 2018; and (8) strengthen BFL's infrastructure as evidence by the development of a comprehensive long-term sustainability plan to provide MHAT beyond this grant period by September of 2021. BFL will train 510 individuals annually and 1,530 over the entire project period in MHFA, an evidence based curriculum. BFL will also reach annually 60,000 adults and youth through "You're Not Alone", a mental health awareness and social media campaign and 180,000 adults and youth over the entire project period with grant funding. By teaching MHFA to our Veterans, armed services members, their families, and community agencies, we are confident that we can make a significant impact by increasing awareness and connecting our population to mental, emotional, and behavioral health assistance. The Coalition's mission is to collaborate with community stakeholders to focus on the prevention of substance abuse and violence while providing opportunities for health and wellness among the community.

B-Care Recovery proposes to provide effective treatment to individuals/families struggling with and impacted by serious mental illnesses (SMIs), co-occurring disorders (CODs), and serious emotional disturbances (SEDs), and to reduce homelessness in Miami, FL. This funding opportunity allows Borinquen Medical Center (BMC), a Federally Qualified Health Center (FQHC), to enhance current outpatient health care services by providing comprehensive, integrated behavioral health and recovery support services to improve clients’ overall wellness and prepare clients to acquire and maintain permanent, secure housing. B-Care Recovery will use evidence-based practices for outreach and counseling services, ones shown to be effective with the homeless population, such as Integrated Dual Diagnosis Treatment (IDDT), Motivational Interviewing combined with Cognitive Behavioral Therapy (MI-CBT), Trauma Incident Reduction (TIR) and Intensive Case Management (ICM). The proposed project, using evidence based practices will address any barriers to care and work closely with community partners to serve the target population and fill identifiable gaps. The goals of the proposed project are to: 1) Increase the number of homeless individuals/families with SMIs, CODs, and/or SEDs who receive integrated mental health and substance abuse treatment; 2) Increase the number of homeless individuals/families with SMIs, CODs, and/or SEDs who have access to healthcare coverage and who receive wellness and medical services; 3) Link homeless individuals/families with SMIs, CODs, and/or SEDs into permanent housing using effective coordinated entry process and wrap around recovery support services over the 5-year period. B-Care Recovery proposes to achieve these goals by providing services to the homeless population of Miami, FL who are experiencing SMIs, CODs, and SEDs which include: outreach services; psychiatric services; individual and family therapy; trauma-focused counseling; targeted case management; linkage to available housing options, both immediate and long-term; intensive outpatient services; substance abuse counseling; wellness coaching; connection to available resources and benefit programs (e.g. SSI, TANF, snap); “wrap around” services; and access to primary care, oral health, pediatric care, OB/GYN, and Ryan White (HIV) services. These services will be provided at BMC and in conjunction with our community partners.

Broward House will implement CLEAR PATHS (Choosing Life! Empowerment! Action! Results! for the Prevention And Treatment of HIV and Substance Use) to intervene in the lives of individuals from racial or ethnic minority groups with Serious Mental Illness (SMI) and/or Co-occurring Disorders (COD) who are HIV positive or at risk for HIVAIDS. The intervention will increase health stability and decrease risk factors linked with HIV transmission and SMI/COD. The intervention will integrate culturally congruent and responsive evidence based services consistently across the continuum of integrated HIV and SMI/COD care including HIV/STI Hepatitis risk reduction, outreach, early intervention medical treatment, substance use treatment services and mental health counseling all delivered in a trauma informed framework. Broward House is an AIDS Service Organization with 30 years of providing services in the community including supported housing, assisted living, case management, substance abuse treatment, mental health and prevention services with a Primary Medical partnership on site. The agency also has active collaborations with community partners who deliver complementary services to support those we serve. Our experience suggests that 75% of the individuals we serve with HIV are diagnosed with a SMI and/or COD. Since 1995, Broward House has operated the only HIV-specific substance abuse treatment program in Broward County and 65% of those clients are racial and ethnic minorities. 60% of those clients self-identify as MSM (men having sex with men). We will continue to serve this at risk population in our CLEAR PATHS program. CLEAR PATHS adopts the CDC’s High Impact Prevention evidenced based approaches of CLEAR and PROMISE. The program will be delivered by 2 master’s degree level Counselors, an Engagement and Retention Specialist, a program coordinator and a Peer Case Manager. The program will provide targeted outreach to increase HIV, STI, and Hepatitis with risk assessments and linkage to services. The program will provide substance use and mental health intervention counseling to the target community and meet the following objectives: Provide substance use and HIV risk reduction education and counseling to the target community serving 180 clients per year and 720 over the 4 year period through the CLEAR and 12 peers per year and 48 over the 4 year period through PROMISE Model. CLEAR is a client-centered program delivered one-on-one using cognitive behavioral techniques to change behavior that can be individually tailored to address the substance use risks of each client. PROMISE utilizes the power of peer stories to promote healthy choices and behaviors. 80% of those enrolled will demonstrate a decrease in risk behaviors and an improvement in health outcomes. Link 100% of individuals who are diagnosed with HIV, Hepatitis or STI with medical care and educate all assessed with risk factors of biomedical prevention care with linkage upon acceptance.

Centerstone Trauma Treatment and Training (CT3) will increase capacity for and access to trauma-focused treatment and services in three Florida counties (DeSoto, Manatee, and Sarasota) for children and adolescents (ages 2-17) and their families who witness or experience traumatic events. CT3 will provide evidence-based/informed trauma treatment for 360 youth (Yr1: 40; Yrs 2-5: 80/annually), including racial/ethnic minorities and children of military families.

CT3 will develop/maintain local capacity to implement trauma-informed practices and provide evidence-based/informed trauma treatment interventions appropriate to the focus population. Project goals include: establishing a community-based, culturally competent project to provide and increase access to trauma-focused treatment/services; developing infrastructure and capacity to implement services; improving the health status and outcomes for young children (ages 2-9) and children/adolescents (ages 10-17); and developing/disseminating a replicable service model.

CT3 will implement the evidence-based/informed Assessment-Based Treatment for Traumatized Children: Trauma Assessment Pathway (TAP), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and Youth Mental Health First Aid. Services include direct trauma/treatment services, therapy, care management, professional training and community education, outreach/engagement, screening and assessment, and linkages to services/supports. CT3 will assess/enhance the EHR to meet project needs. An Advisory Council will provide leadership/guidance and lead sustainability efforts and a Youth Task Force will provide input in assessment, planning, and implementation. Key project partners include child welfare organizations, law enforcement, courts, juvenile justice, and other provider/social service agencies. Comprehensive evaluation of CT3 will result in a model that is well-documented, disseminated widely, and available for replication.

Centerstone ACTion will serve 45 unduplicated adults (18+) with serious mental illness (SMI), including those with co-occurring substance use disorder (COD), who are homeless, and/or involved in the criminal justice system in Manatee and Sarasota counties, Florida (Yr 1: 15; Yr 2-3: 10 annually; Yrs 4-5: 5 annually). ACTion expands and maintains ACT delivery, providing all core model components, including comprehensive screening/assessment, crisis intervention, recovery support services, behavioral health treatment, and care coordination. ACTion’s focus population comprises an anticipated 26,573 (3.3%) catchment area adults with SMI. Focus population demographics are expected to mirror those of Centerstone clients with SMI in the catchment area, with 42% male, 58% female, 76% White, 11% African American, 3% Asian, and 10% Hispanic; 35% are expected to live below poverty and 9% to speak a primary language other than English. Among individuals with SMI, 85% experience unemployment, 36% have less than a high school education, and 14% identify as LGBT. Subpopulations include 7,972 of the focus population who have an SUD, 151 who experience homelessness, and/or 4,260 who are involved in the criminal justice system. In 2017, over 30% of Centerstone clients with SMI had a COD, with 10% experiencing an opioid abuse disorder. Florida has the nation’s 3rd largest homeless population with a mental illness; an estimated 46% of homeless individuals experience SMI and/or SUD. Catchment corrections serve 21,300 offenders, including an estimated 4,260 with SMI, 13,900 with SUD, and 10,440 with COD; only 7% with COD access treatment. ACTion will provide ACT services/interventions according to fidelity, including maintaining a multidisciplinary ACT team to deliver time-unlimited services that are available 24/7. ACT services will be delivered according to the evidence-based SAMHSA KIT, within a Recovery-Oriented System of Care and utilizing a trauma-informed approach. Key ACTion strategies/interventions include community collaborations; development of program standards; outreach/engagement; assembly of ACT Advisory Group; screenings/assessments to screen for COD, crisis, tobacco use, etc. and assess for health conditions and needed supports; development of Individual Recovery Plan; provision of crisis intervention; provision of SMI/COD treatment/interventions/supports, illness management and recovery, case management/care coordination (primary care, tobacco cessation, etc.), peer supports, and other recovery supports (e.g., stable housing, employment assistance, benefits enrollment, activities of daily living); sustainability planning; and dissemination of comprehensive evaluation. ACTion goals include: Implement a comprehensive ACT project; Develop infrastructure and capacity to expand/maintain a comprehensive service continuum; Improve clients’ health/social status/outcomes; and Develop/disseminate a replicable service model. ACTion will achieve the following measurable objectives: Conduct outreach to 250 individuals to increase participation in/access to services; provide training/workforce development for 100 ACT team members/community providers; Reduce mental health symptomatology by 50%; Reduce substance use by 65%; Provide 100% in need with resources to identify/secure stable housing and employment; Reduce costly service utilization/hospitalization by 40%; Reduce involvement with the criminal justice system by 60%; Reduce tobacco use by 10% among those receiving tobacco cessation services; Improve independent living skills among 80%; Increase social connectedness among 70%; and Achieve 80% participant retention. ACTion has secured commitments from partners dedicated to the project’s success and will collaborate with local providers, courts, social service agencies, and other stakeholders.

Children's Home Society of Florida (CHS), in partnership with the University of South Florida (USF) will advance the Trauma Recovery Initiative (TRI) Center through the implementation of Real Life Heroes, a culturally competent, trauma-informed treatment model, in Title I schools across NW Florida.

The TRI Child and Family goal is to improve the lives of 350 children and families annually through a local pilot and the local implementation of Real Life Heroes (RLH) within partnering school districts to promote effective resolution of emotion and behavioral dysregulation reflecting complex trauma including children ages 6-12. Over the course of the length of the grant cycle, 1650 children and their families will be served by RLH. The local focus of the project will be implemented in seven different schools across three counties of Florida's northwest "Panhandle". The TRI project Clinical/Organizational goal is to strengthen CHS as a trauma-informed organization including continued implementation of CPP, PCIT, TF-CBT, and Sanctuary models. The TRI System goal is improving and strengthening the capacity of the local child serving system of care to provide trauma-focused treatment and services in the community. System intervention strategies will include the development of a community-wide, cross sector initiative to identify and mobilize resources to address the holistic needs of children who have already experienced or are at risk of experiencing trauma; as well as to promote community-wide awareness of the impact of trauma and the resources available to prevent and heal trauma.

Citrus Health Network is requesting $400,000 per year for four years from the SAMHSA Primary and Behavioral Health Care Integration grants to improve the coordination and integration of the behavioral health services with the primary care medical services offered in Citrus Health Center clinics. The goal is to improve the physical health status of adults with serious mental illnesses (SMI) and those with co-occurring substance use disorders who have or are at risk for co-morbid primary care conditions and chronic diseases, targeting high risk, low- income, SMI, Hispanic populations. At least 2,000 persons are expected to be served. The four objectives of the program are: 1) Reach level 6 in the SAMHSA/HRSA Center for integrated Health Solutions' Standard Framework for Levels of Integrated Healthcare; 2) improve the health of individuals and reduce health disparities of population with SMI; 3) Enhance the consumer experience of care and 4) Reduce/control the per capita cost of care for the individual, as measured by annual cost of care, before and during their participation in the program. The program will take place in the northwest area of Miami Dade County.

Clay Behavioral Health Center (CBHC) is excited to expand our services in Clay County by collaborating with the Florida Department of Health and other primary care providers in the community to offer integrated physical and behavioral health care to individuals with serious mental health and substance abuse issues. Because everyone matters, we are pleased to partner with SAMHSA in offering services to an often overlooked and underserved population. Through a Primary and Behavioral Health Care Integration grant, the HEALTH MATTERS program will serve at least 460 adults (approximately 115 unduplicated clients each year) with serious mental illnesses (SMI) over a four year period with an expectation to expand services to all CBHC clients, after the four year period. Reducing health disparities among subpopulations will be a focus of the program. Adults with serious mental illness have been shown to have heightened morbidity and mortality, in part due to evaluated incidence and prevalence of obesity, diabetes, hypertension and dyslipidemia. The goal of the program is to improve the physical health status of adults with SMI and those with co-occurring substance use disorders who have or are at risk for co-morbid primary care conditions and chronic diseases. The objective is to support the triple aim of improving the health of individuals with SMI; enhancing the consumer experience of care (including quality, access, and reliability); and reducing/controlling the per capita cost of care.