GU Discretionary Funding Fiscal Year 2020

The U.S. territory of Guam is seeking emergency funding to support mental health treatment for the community amidst the COVID-19 pandemic. The Guam Behavioral Health and Wellness Center (GBHWC) has been the island's only state agency for mental health and substance use services since 1983. The proposed populations of focus include 1) adults 18 years of age and older with a Serious Mental Illness (SMI), Substance Use Disorder (SUD), and/or Co-Occurring Disorder (COD); 2) Healthcare professionals and first-responders experiencing a mental disorder less severe than SMI as a result of COVID-19; and 3) Other individuals 18 years of age and older experiencing mental disorders less severe than SMI as a result of COVID-19. GBHWC reported over 3,300 clients in 2019 with approximately 2,000 individuals diagnosed with an SMI, 800 experiencing an SUD, and roughly 600 experiencing a mental disorder less severe than SMI. These numbers are expected to increase drastically as the island continues to see community spread. As the closest U.S. soil to the epicenter of the disease, Guam is experiencing added concerns due to its dependence on tourism from Asian countries considered hotspots of COVID-19, including China. Despite its small but diverse population of 159,000 people, Guam's Department of Labor estimates over 38,000 people will need unemployment assistance as a result of COVID-19. In 25 days, Guam confirmed 128 positive COVID-19 cases that resulted in 4 deaths. In addition, the USS Theodore Roosevelt aircraft carrier docked in Guam, with over 200 of their 5,000 sailors testing positive for COVID-19. Additionally, healthcare professionals continue to face great risks of contracting the Corona virus due to the national shortage of Personal Protective Equipment (PPE) to safeguard them as they treat the community, with anxiety and fear growing after 13 healthcare workers have reportedly already contracted the disease. Compounded with that, is a shortage of medical professionals across the island, further proving how imperative it is to ensure that mental health treatments and supports are available to them. This emergency funding is needed to build GBHWC's capacity to provide continued mental health services and supports to the identified populations during this public health emergency. In keeping with the Governor's mandate of social distancing, the applicant organization proposes to utilize Telehealth in its service provision of evidence-based practices, through videoconferencing and telephone. GBHWC proposes to use grant funds to serve 150 individuals in addition to the over 3,300 consumers annually, as a direct result of this COVID-19 pandemic.

Guam Behavioral Health and Wellness Center (GBHWC), the island’s only state agency for mental health and substance use, is seeking emergency funding in response to the growth in urgent mental health care caused by COVID-19. While Guam is only 30 miles long and 4-12 miles wide, Guam’s suicide mortality rate remains significantly higher than the U.S., with our age-adjusted rates being over twice that of the nation. Guam’s Bureau of Statistics & Plans (BSP) reported in 2018 that suicide was the sixth-leading cause of death among residents, with one occurring every eight days. Three days after the first confirmed positive COVID-19 case on island, GBHWC staffed the 24-hour Crisis Hotline that saw a dramatic increase of calls from an average of 25 per month to over 20 per day, with calls varying from general COVID-19 anxieties about health and employment, suicide ideations as a result of home quarantine with a violent spouse, to active suicide attempts stemming from hopelessness and despair. The proposed population of focus is individuals 25 years of age and older, who are at-risk for suicide during the COVID-19 pandemic, including victims of domestic violence. As reported by NASMHPD, between 2014 – 2018, over 1,300 calls were made from Guam to the National Suicide Prevention Lifeline’s 1-800 number and 0% of them were able to receive help nearby because there are no crisis centers on island. In 2019, GBHWC serviced over 70 clients who disclosed being victims of domestic violence. These numbers are expected to drastically increase as the island remains under stay-at-home orders. Additionally, Guam’s Department of Labor has already received information from employers that more than 18,000 workers have been directly affected by the COVID-19 pandemic, and they project about 20,000 more are going to file for unemployment benefits in the coming weeks. As these numbers continue to increase, the community persistently is faced with heightened stress, fear, and anxiety, while adjusting to the severity of acute shifts in lifestyles such as mandatory home isolation, travel quarantines, and job loss. Guam has already seen an increase in suicide attempts and suicidal crises with more and more people being transported to GBHWC from all three Emergency Departments (EDs). Guam’s COVID-19 Emergency Response for Suicide Prevention funds will help expand GBHWC’s capacity to support the community through the expansion of telehealth services, a 24/7 crisis hotline, and the establishment of formal transition and discharge protocols with EDs promote a comprehensive approach to suicide including those affected by domestic violence. During the project period, GBHWC aims to serve 200 individuals on top of the average 3,300 consumers annually.

“Ma’lak na ha’åni” or Bright Futures, is WestCare Pacific Islands, Inc.’s (WPI) proposed trauma treatment program for youth ages 11-17 living on Guam in the aftermath of federally declared disaster Typhoon Mangkhut in 2018 (DR-4398). WPI, collaborating with cross-sector community partners including Guam Department of Education, Guam Behavioral Health and Wellness Center, Coalition for a Drug Free Dededo, Department of Youth Authority, and Sanctuary, Inc., will provide critical mental health support and treatment services for this vulnerable population through school site-based programming at two middle schools and one high school in central and northern Guam in the geographic catchment area of zip codes 96912 (Dededo), 96929 (Yigo), 96910 and 96932 (Hagatna), 96923 (Mangilao), and 96926 (Sinajana). The Evidence-Based Practices to be used in Bright Futures are Support for Students Exposed to Trauma (SSET), Screening, Brief Intervention, and Referral to Treatment (SBIRT), Cognitive-Behavioral Therapy (CBT), Cognitive-Behavioral Intervention for Trauma in Schools (CBITS), and Motivational Interviewing (MI). Services will be provided by three full-time clinicians and three youth service specialists with expertise in helping this specific population, and supported by a full-time Project Director, Evaluation Director, Research Assistant, and Administrative Assistant. Eighteen percent of Guam’s population is between the ages of 10-19, and one in 10 experience mental health problems, according to the Guam Behavioral and Wellness Center. The nonprofit Save the Children reported in 2010 that needs of children who live through a disaster include mental health needs; however, the organization reported to Congress in 2015 that of 81 recommendations for providing disaster-related treatment, only 17 had been fully met. WPI and partners will provide evidence-based, developmentally appropriate school- based mental health services including crisis counseling, direct mental health treatment services, coordinated referrals to community services, and follow-up to 50 students and their families at each site, for a total of 150 students during the life of this grant, if awarded. The project will also execute a workforce development training plan to increase mental health awareness and literacy of school staff, administrators, parents, and others who interact with these children, deepening and expanding community relationships to better serve the families of children affected by this disaster.

The Guam Focus on Life Program (GFOL) is a strategic effort led by the Guam Behavioral Health and Wellness Center (GBHWC) to increase suicide prevention, intervention and postvention skills among direct service providers and natural helpers, to break the stigma on mental health and help-seeking, and to improve the standards of suicide-safe care for at risk youth ages 10-24. Building upon the successful outcomes of the 2008 and 2012 iterations of the grant, GBHWC will continue to use the 2019 GLS State/Tribal Youth Suicide Grant to reach this target population, which comprises 26% of Guam’s total population; with particular focus on youth experiencing grief, feelings of pain and loss, or suicide thoughts and behavior. GFOL has three fundamental goals: 1) At risk youth experiencing grief and feelings of pain and loss, or having suicidal thoughts and behaviors openly seek help from natural helpers and appropriate behavioral health services; 2) GBHWC, the island’s mental health agency, transforms its culture and services to achieve excellence in providing patient safety and safer suicide care; 3) Guam’s youth-serving providers operate in an integrated system of care that safely responds to individuals at risk for suicide. To pursue these goals, GBHWC is committed to achieving these objectives under GFOL. By 2024, 500 natural helpers will be trained to identify and refer at risk youth to appropriate services through evidence-based programs. GBHWC will revise Guam’s Youth Suicide Strategic Prevention and Intervention Plan to incorporate epidemiological inferences based on qualitative data offered by youth and adults with lived experience surviving either suicide loss or suicide attempt. In partnership with the University of Guam, GBHWC will add depth to the annual suicide statistics report by including researched qualitative data to inform future strategies on risk and protective factors that are unique to the island community. GFOL will also invest in at least three evidence-based programs that will normalize positive coping skills and increase help-seeking behavior among at risk youth, specifically those in Guam’s public school system, those completing their treatment from the local hospitals and psychiatric patient units, and those receiving support from youth-serving organizations. GFOL will utilize the Zero Suicide Framework (ZSF) to improve GBHWC’s ability to provide evidence based suicide-safer care to patients. By 2024, GFOL will implement the ZSF in all aspects of GBHWC’s services; including its local crisis hotline to operate as a member of the National Suicide Prevention Lifeline (NSPL) network, receiving at least 70% of NSPL calls from the island locally. Lastly, GFOL will establish a Suicide Prevention Task Force, made up of key direct service providers for youth at risk for suicide, work collaboratively to ensure that they are trained to identify, screen, refer, treat and follow-up on at risk youth, creating a synergetic support system. All proposed objectives and strategies for GFOL will be continuously evaluated and improved for effectiveness to reach a total of 2,646 in Year 1, 13,550 for the life of the GLS grant.

WestCare Pacific Islands, Inc. (WPI) will create an evidence-based Drug Free Communities Support Program entitled the Coalition for a Drug Free Dededo (CDFD) for youth (individuals 18 years of age and younger) in ZIP codes 96929 and 96912 in the Village of Dededo, Guam. Dededo is the most populated village in the United States territory of Guam. Since the existence of WPI in 2009, its partners and collaborators have worked together on substance abuse reduction initiatives that identify and address local youth substance problems. There is a significant implication for effective service delivery, highlighting the need for culturally competent communications and services for close to half of the island’s population. Within the village of Dededo 51% of the population is born outside of Guam, comprised of a variety of nationalities in addition to native Pacific Islanders which oftentimes creates significant language barriers. Not only are there language barriers for these individuals in the community at large, and between parents and their children (8% of the population in Dededo is between 10 and 19 years old), but there are often languages barriers within the media and advertising. As evidenced by the Guam data presented by Guam’s State Epidemiological Workgroup (SEW), there is a high prevalence of detrimental social, economic, and health consequences arising from tobacco, alcohol, and other substance use and abuse, including underage drinking and smoking on Guam. Substance abuse prevention is addressed as a major public health priority for the island proving significant gaps in the current state-level infrastructure. The CDFD goals include increasing community collaboration and decreasing Youth Substance Use; (Alcohol, Marijuana, and Tobacco) and drug deaths related to overdose. There will be an increase in the membership of the CDFD, existing resources and gaps to address CDFD goals will be identified. There will be increased internal capacity to prevent youth substance use and overdose deaths. Needs assessments will be conducted and skills training will be provided to increase knowledge of CDFD members. The CDFD will serve 1,569 individuals annually and 7,845 throughout the lifetime of the project.

WestCare Pacific Islands, Inc. (WPI) is seeking $300,000 annually for five years to reduce and prevent alcohol and marijuana use by 15% by youth ages 10-18 on Guam through Maolek Na Lina’La (“Life is Good”), a broad approach expanding community prevention strategies through comprehensive Needs Assessment, Capacity Assessment, and Environmental Scans and incorporating input from the community-at-large. Working with a cross-sector coalition including the Mayor’s Office, schools, key leaders, and community stakeholders, and accessing the resources of the Prevention Technology Transfer Center, this proposed program will work to modify and change policies that enable underage drinking and marijuana use while increasing social support for substance-free lifestyles through the community-wide Champion Campaign, which will coincide with National Awareness Month in September. A key strategy is enlisting the participation of youth through training five (5) Peer Leaders each year from among the target population to assist in the development and implementation of messaging, public awareness and media campaigns. Concurrently, Maolek Na Lina’La will deliver the evidence-based curriculum Positive Action with community and 250 unduplicated middle- and high-school youth per year, and conduct parent-directed Communication Campaign to 125 parents of 1) middle school-age youth that includes the evidence-based Talk. They Hear You campaign PSAs; 2) middle- and high-school students on local Social Host laws and consequences before Homecoming, Prom, and pre-graduation events, Parent-Teacher Organization meetings, and other related events. Environmental strategies will include signage at “mom ‘n’ pop” stores and public gathering spaces. All program components will be delivered to enhance access and reduce barriers in a multicultural, multilingual approach that is compatible with the unique cultural composition of Guam. Through this multipronged strategy, families and adults over age 26 will also receive important messaging regarding substance use and prevention, thereby effecting positive change throughout the community. Through this program, WPI and community partners Department of Education, Department of Youth Affairs, Guam Behavioral Health and Wellness Center, Mayor’s Council, Payu-Ta, Office of Catholic Education, and Coalition for a Drug-Free Dededo (CDFD) will expand the work and effectiveness of the State Epidemiology Work Group and CDFD, funded through SAMHSA’s Drug-Free Communities program. To accomplish the overall target reduction in alcohol and marijuana by 2025, as measured by the Youth Risk Behavior Survey and focus groups, WPI will employ a Project Director, Lead Epidemiologist/Research Assistant, two Prevention Specialists, and the services of WPI’s Vice President of Operations and a contracted Evaluator through WestCare’s Research and Evaluation Department. Ultimately, this program will not only achieve the target outcomes of substance use reduction and prevention, but change attitudes, norms, and ultimately youth behavior regarding substance use.

The Guam Opioid Response Project (GORP) is designed to increase access to substance use treatment, recovery support services and prevention activities to reduce the prevalence of Substance Use Disorders and Opioid Use Disorders amongst our young adult population ages 18-25. GORP intends to develop and implement a treatment program designed for young adults. The SOR funding will support the treatment of 25 participants in the first year of funding and 50 participants in the second year of funding. If the project continues to increase participation of young adults to the program, other local and federal funding will support the efforts of the project. Guam Opioid Response Project will also launch a Substance Abuse Prevention Campaign that will focus primarily on Youth ages 12 -17. This Youth Campaign will focus on increasing the capacity of the local middle and high schools, to reduce high risk behaviors of students that may contribute to substance abuse, to include tobacco use and vaping. Measurable prevention objectives to reduce OUDs and opioid-related deaths will include: increasing community knowledge and awareness through trainings and evidence-based programs and practice; and increasing access to Screening, Brief Intervention and Referral to Treatment (SBIRT). Measurable treatment objectives to reduce OUDs and opioid-related deaths will include: stigma reduction and knowledge of Medication Assisted Treatment (MAT); and increasing access to peer support services. Target populations will include young adults ages 18-26 with a Opioid Use Disorder (OUDs) and/or Substance Use Disorders (SUDs) and youth ages 12-17 in local middle and high schools.

The Judiciary of Guam submits this FY 2020 SAMHSA Adult Drug Court Enhancement Project for enhancement of an Adult Treatment Drug Court (ADC). The goal is to reduce substance abuse and criminal activities related to substance use among judicially involved clients. The implementation approach involves the expansion of participant slots in the ADC and enhancements to address emerging substance use trends and needs of the clients in the program. The population of focus is current ADC participants and probationers adjudicated with drug charges pending admission upon availability of program slots. Pretrial detainees with primary charges of drug offenses will also be considered for the program after case adjudication or deferred plea. ADC is a judicially-supervised program that allows eligible defendants the opportunity to engage in treatment while on probationary status. The primary treatment program is the Matrix Model, a curriculum proven as effective with stimulant-based addictions like methamphetamines, the current drug of choice for a majority of probationers. In 2019, ADC’s current capacity of 20 participants annually was exceeded, resulting in a 180% intake rate. The rise in intake and increased referrals to ADC equate to the need for expanding ADC slots to serve the population in most need. The project proposes to serve 20 current and 20 new participants by the end of Year 1; adding 40 new participants each year thereafter, for an unduplicated total of 200 participants served by the end of the project period (Objective 1). This enhancement project seeks to address emerging substance use trends and needs of the target population through the addition of opioid-focused treatment, addressing co-occurring disorders, and increasing access to residential treatment services. By the end of the fourth month and throughout the project, enhancements to the ADC treatment services will include the implementation of Helping Men Recover, Moral Reconation Therapy, Cognitive Behavioral Interventions programs and residential treatment services (Objective 2). ADC recognizes the need to enhance the capacity of treatment providers to address the rise of opioid use and addiction on Guam. As a proactive measure to prevent an opioid crisis, the project proposes to expand ADC services by implementing at least one substance use treatment focused on opioid use and/or co-occurring disorders (Objective 3). Guam’s ADC addresses the National Association of Drug Court Professionals 10 Key Components of Drug Courts. The project proposes that by the end of the fourth month and throughout the life of the project, ADC will procure the resources and supplies needed to ensure fidelity to the drug court model (Objective 4). The proposed project will enable additional participants to benefit from immediate access to evidence-based services, treatment planning, and increased monitoring that is responsive to their treatment needs while program enhancements will address current program gaps and assist less advantaged participants with barriers to treatment such as the need for additional support.