FL Discretionary Funding Fiscal Year 2020

Project THRIVE will provide evidence based Wraparound services for 180 students during the 18 month period. Target population will be children requiring services from existing Mobile Response Teams. The wraparound facilitators will provide a strength-based, team-supported planning process to achieve highly individualized plans to address complex emotional and behavioral needs of k-12 students in four counties. The project will target the children referred for involuntary evaluations under the Florida Baker Act. (70% increase in cases year to year)

Project RISE (Recovery Interventions and Service Enhancements) will address the 29% increase in parents with foster home placements and 21% increase in parents of maltreated children who remained "in-home" in Bay County, Florida. The 18 month project will serve 180 diverse individuals who are: 1) parents whose behavior health disorder is a contributing factor to child welfare system involvement (especially those with children at risk of removal); and 2) young adults with past and or current trauma exposure who have "aged" out of the local foster-care system and have no family support or any supportive network and are now in independent living status.

Centerstone COVID-19 Emergency Response to Suicide Prevention in Florida (FL-ERSP) will advance efforts during the COVID-19 pandemic to prevent suicide and suicide attempts among adults age 25 and older, including victims of domestic violence, in Manatee and Sarasota counties, Florida. FL-ERSP anticipates serving, at minimum, an unduplicated total of 125 adults in the 16-month project period, based on considerations including area/population need, staff caseload/capacity, and timeframe for meeting client care needs. FL-ERSP’s focus population demographics are expected to mirror those of the catchment area, with 47% male, 53% female, 83% white, 5% African American, and 9% Hispanic/Latino individuals ages 25+. FL-ERSP will place special emphasis on supporting victims of domestic violence, comprising a reported 0.4% of the area’s population. Prior to the pandemic, suicide rates among the focus population far exceeded the nation and state (26.7/100,000 vs. 14.5 and 21.5); these rates are expected to rise as a result of the COVID-19 crisis. In response to the COVID-19 pandemic and related behavioral health needs, FL-ERSP will provide rapid follow-up, including care transition/coordination services, among clients who have attempted suicide or experienced a suicidal crisis after discharge from emergency departments (EDs) and inpatient psychiatric units (IPUs), and help clients secure a mental health appointment within a week of discharge. FL-ERSP will assess clients’ risk level using the Patient Health Questionnaire-9, Columbia-Suicide Severity Rating Scale, the Interpersonal Needs Questionnaire, and the Partner Violence Screen (PVS). A crisis management plan will be developed for those at high risk comprising of safety planning, reduced access to lethal means crisis intervention, continuous contact/monitoring, and rapid follow-up. Victims of domestic violence and their dependents will be provided enhanced services, including a safe place to stay if they are unable to remain safe in their home. FL-ERSP suicide-specific evidence-based practices include RELATE; the Interpersonal Theory of Suicide (ITS); Cognitive Behavioral Therapy-Suicide Prevention (CBT-SP); Suicide-Prevention Focused Narrative Exposure Therapy (S-NET); Dialectical Behavioral Therapy-Skills Treatment (DBT-ST); Attempted Suicide Short Intervention Program (ASSIP); and Counseling on Access to Lethal Means (CALM). FL-ERSP will accomplish the following goals: 1) Develop/implement a plan for rapid follow-up after discharge from EDs/IPUs; 2) Provide follow-up and care transition/coordination services; 3) Enhance/expand community and clinical service provider training; 4) Develop/expand collaborations with relevant state/community organizations/departments/systems to implement comprehensive suicide prevention; 5) Enhance/expand community recovery supports for clients and household members; and 6) Conduct a comprehensive evaluation. FL-ERSP objectives will measure the number of screenings/assessments and rapid follow-up conducted; services (including telehealth services), care transition, and care coordination delivered; and community/clinical trainings conducted, as well as outcomes related to substance use, employment status, housing stability, suicidality, and social connectedness among participants. FL-ERSP has secured commitments from partners, including domestic violence organizations, who are dedicated to the project’s success and who will serve as linkage/referral sources; provide recovery support services; and take part in project trainings, Advisory Council, and Evaluation activities.

DISC Village, Inc. will expand capacity of Evidence-based Prevention Education and Youth Counseling services utilizing qualified professionals in schools to decrease symptomology of trauma exposure from Hurricane Michael. DISC Village, Inc. will provide universal strategies to increase awareness of mental health related challenges for school administrators and personnel to encourage youth to engage in services that meet individualized behavioral health needs. An estimated 40,000 students are actively enrolled in the public school systems within Leon and Wakulla Counties for the 2019-2020 school year. In the months following Hurricane Michael, these Districts saw a surplus of 300 new students relocating as a direct result of the storm. These students demonstrated challenges with mental wellness brought on by the experience of a traumatic event including, but not limited to, fear, anxiety, social-disconnectedness, and depression, all while trying to navigate a new community and school setting. The expansion of Prevention Services will include Evidence-based education models that incorporate strategies aligned with Cognitive Behavioral Therapy (CBT) including psychoeducation about reactions to trauma, relaxation training, stress or trauma exposure, and social problem-solving. Prevention Services’ goal is to reduce symptoms related to PTSD and trauma exposure among students. Pre and post interviews will be conducted by staff, incorporating screening tools identifying anxiety, fear, depression, and self-esteem. Students will complete activities to build social skills, enhance resiliency to stress, and identify ways to advocate for peer and caregiver support. The expansion of Youth Counseling services will include targeted therapeutic mental health counseling utilizing Evidence-based modalities of Motivational Interviewing, Dialectical Behavior Therapy (DBT), Cognitive Behavioral Therapy (CBT), and Solution-Focused Brief Therapy (SFBT). Youth Counseling services’ goal is to enhance self-sufficiency and self-esteem, and promote the resolution of the underlying challenges with emotional wellness among students. A comprehensive biopsychosocial assessment will be conducted by staff to determine need for services. Students will collaborate with counselors to develop a comprehensive treatment plan that identifies personal strengths, needs, abilities, and preferences. Individualized goals and objectives will be addressed in weekly one-on-one sessions. The Organization is projected to serve 375 students annually and approximately 5,500 individuals during the lifetime of the project to include students in both Prevention and Youth Counseling Services, school faculty and staff, and community members.

The Northwest Florida First Responder Resiliency Project is a multi-faceted, evidence-based outreach and intervention approach to addressing the behavioral health needs of firefighters (n = approx. 2,500) in Hurricane Michael impacted areas of the Florida panhandle. The program consists of 4 primary components: linking first responders with evidence-based assessment, screening, and tele-behavioral health services; peer support capacity building; education to promote mental health literacy (MHL); and leadership coaching to address stigma and culture change. These components address the most pressing issues in linking firefighters with appropriate mental health and substance use services: shortage of local providers, providers lacking cultural competency with first responders, inadequate insurance benefits, stigma, lack of awareness and misunderstandings regarding mental health issues, and fear of employment consequences for seeking services (leadership culture). Hurricane Michael exacerbated the existing severe mental health provider shortages in the western Florida panhandle. High levels of rurality and socioeconomic challenges in this area strongly correlate with more critical and persistent mental health issues after a disaster. First responders are also at higher risk for undiagnosed and untreated mental health issues and less likely to engage in help-seeking behaviors. Given firefighters were both residents of the disaster area as well as first responders in the situation, they remain at high risk for serious mental health issues. In addition to rurality, stigma, pride, shame, misunderstandings about mental health concerns, and employment culture prohibit firefighters from accessing care locally. However, telehealth can address both proximity and cultural barriers. Telecounseling by licensed mental health providers has been demonstrated an effective technique for delivery of evidence-based trauma informed therapy modalities, which may be helpful in the repeated exposure to trauma experienced by firefighters. Evidence indicates involvement in organized peer support networks can attenuate mental health symptoms and provide protective factors among firefighters. Trained peers serve as advocates providing education and awareness so more firefighters may recognize the early signs and symptoms of mental health issues and seek treatment, decrease stigma regarding mental health and substance abuse issues, increase access and linkages to appropriate professionals. Evidence also links increases in mental health literacy with increased access to screening and treatment and reduction in stigma. Project directors will customize and deploy a wide-reaching digital campaign to improve mental health literacy among first responders. Leadership behaviors are predictive of stigma and practical barriers to mental health treatment. Given the hierarchical nature of leadership in the fire service, leaders possess a unique and powerful opportunity to create culture shifts to reduce stigma regarding mental health treatment in firefighters. Relying on the theories of planned behavior change, the program will help leaders adopt a more positive, trauma-informed perspective on mental health issues.

Florida intends to use $1,800,000 in grant funds to purchase an array of behavioral health services for the target populations identified in the Request for Application. Specifically, $600,000 will be allocated to IMPOWER (through the Central Florida Cares Health Systems managing entity) to provide psychiatric and therapeutic services via telehealth for healthcare practitioners and individuals experiencing mental health and/or substance use issues as a result of COVID-19. The remaining $1,200,000 will be allocated to managing entities based on highest impact of COVID-19 in their service area to serve individuals with serious mental illness and/or substance use disorders. These funds will purchase crisis intervention, behavioral health treatment, and recovery support services.

Florida's Hurricane Michael Disaster Response Project will focus on continued recovery efforts for both children and adults who are experiencing substance misuse, stress, anxiety, depression, or other behavioral health symptoms, and in need of mental or substance use disorder treatment, crisis intervention, care coordination and other supports. Primary focus will be on school age children through partnerships with local school districts. Schools in the affected areas have reported that as a result of the trauma form directly experiencing the storm, and the complicated physical, psychological, and financial ongoing recovery, there has been a dramatic increase in mental health referrals. This is expected to be compounded by the mental health impact of the COVID-19 pandemic. For adults, one focus area will be parents with child welfare involvement who present with behavioral health conditions. Data from the area's network management agency for child welfare show that 438 children have been placed in foster care services since the date of the storm. Reunification efforts are hampered by limited access to needed services for the parents of these children. Consistent with pre-hurricane trends, many of the parents are presenting with substance use disorders or co-occurring mental and substance use disorders. Funds will also be allocated to community service providers for a comprehensive array of treatment and recovery support services for adults with mental and substance use disorders who were impacted by the hurricane. Franklin, Liberty, Bay, Gulf, Jackson, Calhoun and Washington counties in the Florida panhandle will comprise the target area served with grant funds.

To help students respond to the effects of Hurricane Michael, the Florida Department of Health has partnered with the National Center for School Mental Health, Life Management Center of Northwest Florida Inc. to work with Bay, Calhoun, Gadsden, Gulf, Jackson and Liberty School Districts in developing the infrastructure and capacity of these school districts impacted by this hurricane. The goal is to implement and sustain high quality, trauma-responsive comprehensive school mental health systems that provide evidence-based, trauma-responsive mental health services, including crisis counseling, to indicated youth, including Cognitive Behavioral Intervention for Trauma in Schools (CBITS) and Bounce Back. Additionally, the initiative will increase the mental health awareness and literacy of all school staff in the six school districts via training in Youth Mental Health First Aid and the overall trauma-responsiveness of each school, using the Trauma-Sensitive Schools Training Package. These services will be targeted towards the students in public pre-kindergarten through 12th grade schools in the aforementioned school districts.

The Evidence Based Substance Use Disorder Curriculum for Social Work Students project is a multi-university initiative aimed at developing a new substance use disorder (SUD) curriculum for undergraduate and graduate social work students. For that purpose, Florida State University (FSU) Center for the Study and Promotion of Communities, Families and Children created the Florida Higher Education Substance Use Disorder Consortium ('the Florida Consortium') of 11 university social work programs at Barry University, Florida Agricultural and Mechanical University, Florida Atlantic University, Florida Gulf Coast University, Florida Memorial University, Florida State University, Saint Leo's University, University of North Florida, University of South Florida, University of West Florida, and Warner University. The Florida Consortium universities are more diverse than the national average; and consortium member universities are located in rural and urban areas. This cooperative network of Florida universities has the goal of collectively developing a SUD curriculum, piloting the curriculum at the FSU College of Social Work during the first year of the project and then rolling out the curriculum in the other 10 universities during the second year of the project. The basic requirements for the new SUD curriculum include 15 key content areas ranging from concepts of SUDs, screening, assessment, the application of evidence-based practices in treatment and recovery, cultural competency in SUD services, ethics, prevention, and clinical supervision. FSU and the Florida Consortium universities will be able to integrate content areas from the curriculum into their core courses in addition to developing electives specifically dedicated to SUDs. The curriculum will address population-specific competencies for elderly, homeless, pregnant women, veterans, and adolescent clients paying attention to alcohol, marijuana, stimulants and opioid misuse. The project will also include working with the Association of Social Work Boards (ASWB), a project partner, to develop an evidence-based set of examination items on substance use disorders to be recommended for inclusion in licensure exams in social work across the U.S. and Canada. In addition to the universities, Citrus Health Network and the National Association of Social Work - Florida, have partnered with the FSU and the Florida Consortium for the curriculum project. SUD have important implications for the health and well-being of individuals, families, and communities in the United States. Social workers are likely to encounter clients with SUD in a wide array of settings, suggesting that social workers need to have a solid understanding and conceptual foundation in substance use disorder treatment practices and concepts.

Guidance/Care Center (G/CC) COVID-19 ERSP Project will enhance current programming that prevents suicide and suicide attempts among at-risk adults age 25 and older in the Florida Keys. Since 2014, Monroe County, Florida, home of the Florida Keys, had the highest suicide rate in the state (24.29%). Monroe County, is home to approximately 73,090 people, mostly living on the islands of the Florida Keys. Monroe County residents do not have money to pay for Mental Health services, 48% of the target population is uninsured, 32% are unemployed and another 48% qualify as ALICE (Asset-Limited, Income-Constrained, Employed). The racial makeup of the county was 89.5% White (71.3% Non-Hispanic White), 5.7% Black or African American, 0.4% Native American, 1.1% Asian, 0.1% Pacific Islander, 1.4% from other races, and 1.8% from two or more races. 20.6% of the population were Hispanic or Latino of any race. The G/CC existing continuum of integrated care is a one-stop shop including substance abuse and mental health services. G/CC provides mental health, crisis and suicide prevention services to persons referred by the police departments, emergency rooms, service providers and self-referrals. The full continuum of care includes assessment, intervention, and treatment services available county-wide at all 3 locations in Key Largo, Marathon, and Key West, as well virtually via G/CC Telehealth. G/CC also is a designated provider for Medicare, Medicaid, Healthy Kids/KidCare and accepts many commercial health insurance plans to assist families. The staggering number of unemployment and uninsured in this, high cost of living community are in desperate need of the proposed mental health services that will be covered by this grant. Project goals, each with measurable performance objectives are to: Goal 1 - Increase the availability of and access to services to prevent suicide and suicide attempts among adults, aged 25 and older. Objectives include: Providing evidence-based services to 100 individuals across the 16-month funding period with 75% of participants completing services. Goal 2 - Enhance the emotional and social functioning of among adults, aged 25 years or older. Objectives include: 80% of clients completing services having anxiety, depression, or trauma symptoms at admission will exhibit fewer symptoms at discharge, 70% of those will maintain the improvements or show additional decreases at 6-months post admission. 70% of clients having suicide ideation at admission will show decreases in ideation at discharge, 70% of those will maintain the improvements or show additional decreases at 6-months post admission assessed by the Beck Suicide Ideation Scale. 80% of the clients completing services and not having stable living arrangement at admission will have stable living arrangements at discharge, 70% of those will maintain their living arrangements at 6-months post intake. 80% of the clients completing services will have improved social evidenced. 80% of the clients completing services will be in an educational/vocational program, seeking employment, or employed at discharge, 70% will continue to remain enrolled, complete their education/training, or remain employed at 6-months post admission as evidenced by the GPRA.