IA Discretionary Funding Fiscal Year 2023

Iowa 988 Capacity Building Project The Iowa Department of Human Services (DHS), Division of Mental Health and Disability Services – Community (MHDS-C) is the applicant agency for the FY2022 Cooperative Agreement for States and Territories to Build Local 988 Capacity in Iowa. Iowa’s 988 State Planning Team, comprised of DHS and Iowa Department of Public Health (IDPH) staff, will collaborate with Iowa’s two Lifeline Network Centers (Lifeline Centers), CommUnity Crisis Services and Food Bank (CommUnity) and Foundation 2 Crisis Services (Foundation 2) to implement 988 in Iowa. Increasing Iowa’s capacity to answer 988 contacts originating from Iowa will improve answer rates in Iowa, ensure Iowa contacts are first routed to Iowa’s Lifeline Centers, and increase access to local behavioral health services. DHS will work with Iowa’s two Lifeline Centers to identify, recruit, hire, and train the needed behavioral health workforce for the successful implementation of 988. Iowa’s target population is any Iowan experiencing a behavioral health crisis. Iowa anticipates 77,056 clients to be served through this grant, 30,100 during year one and 46,956 during year 2. During SFY2021, Iowa answered 10,975 calls originating from Iowa, for an answer rate of 67%. During FFY2021, Iowa answered 2,356 chats and 1,009 texts. Since chats and texts are not routed by location, it is unknown the number of chats and texts Iowa answered that were from Iowa. Vibrant Emotional Health estimates Iowa will handle 71,800 contacts including follow-up contacts between July 15, 2022, and June 30, 2023. Iowa has been building a mental health crisis system for many years. Iowa’s 14 Mental Health and Disability Services Regions (MHDS Regions) develop and provide access to the following crisis services for adults: access centers, crisis evaluation, crisis stabilization community-based and residential services, mobile response, subacute services, 24-hour access to crisis response, and 23-hour crisis observation and holding; and the following crisis services for children: crisis stabilization community-based and residential services, and mobile response. Iowa’s 988 State Planning Team facilitates ongoing communication with stakeholders on the development of the implementation of 988 in Iowa. Iowa’s 988 State Planning Team has received stakeholder feedback on areas to consider and focus on throughout 988 implementation. Iowa will review contact metrics monthly, quarterly, and annually to continually assess in-state answer rate and identify areas of need (i.e., additional staff). During this review process, Iowa will also review contacts resulting in emergency rescue, suicide attempts in progress, and mobile crisis outreach referrals. This review of contact metrics will support the longevity of successful implementation and sustainability of 988 in Iowa. Iowa’s Lifeline Centers work closely with the Department of Veteran’s Affairs to ensure appropriate linkage to the Veterans Crisis Line occurs for veterans, service members, or their families upon request. Iowa will also provide attention to development of appropriate policies on intervention and follow-up through 988 for American Indians/Alaskan Natives (AI/AN). State-specific behavioral health data is not available for these populations, but nationally, have a higher-than-average suicide rate. Iowa received a Transformation Transfer Initiative (TTI) award in December 2021 which will be used to provide two standardized training toolkits for Iowa’s 988 and behavioral health crisis workforce specific to serving children and LGBTQ+ individuals.

The Iowa Department of Health and Human Services (Iowa HHS) is proud of the behavioral health (BH) services offered to our residents, but we recognize the need to expand comprehensive, person-centered, trauma-informed, and evidence-based care to Iowans who experience BH conditions, particularly those with the most serious BH needs. Under our project titled the Iowa Certified Community Behavioral Health Clinic (CCBHC) Planning Grant, and through our participation in the CCBHC Demonstration Program, Iowa will certify and reimburse eligible clinics that serve individuals with BH conditions, including individuals with Serious Emotional Disturbance (SED), Serious Mental Illness (SMI), and significant Substance Use Disorders (SUD). Certified CCBHC will be available to serve Iowa’s residents who have a BH need, including an estimated 573,500 with Any Mental Illness and 248,000 with a SUD. Iowa HHS is committed to ensuring access to culturally competent services for members of historically underserved and marginalized groups, as well as members of groups experiencing poor behavioral health outcomes, including youth and adolescents experiencing SED and substance use (SU) conditions, adults with SMI and/or significant SUD, pregnant and parenting women, and veterans. While Iowa HHS is very proud of the service delivery systems we have built, and our success in weaving those service delivery systems together, we recognize that significant barriers remain that prevent Iowans from achieving optimal health outcomes. Both stakeholders and data analyses point us to vulnerable communities and priority populations that have the greatest needs for increased capacity and access. Iowa HHS will leverage the CCBHC initiative to promote further integration and alignment with the healthcare delivery system, increase the system’s capacity to offer evidence-based practices, and standardize service delivery. The CCBHC stakeholder engagement, technical assistance, learning community, and certification readiness activities will aid in improving outcomes for CCBHCs and their Designated Collaborative Organizations. We will support our provider community as they implement the cultural, procedural, and organizational changes necessary to become CCBHCs and deliver high quality, comprehensive, person-centered, and evidence-based services that are accessible to the populations of focus. This will require us to assist CCBHCs with improving the cultural diversity and competence of their workforce by recruiting from the populations of focus and providing evidence-based resources and supports to promote their skills and build career ladders. The process of developing the initiative and preparing providers to participate in it will make it possible for Iowa HHS to build the capacity of our providers, and the accountability CCBHC funding will make it possible for Iowa HHS to ensure that the additional capacity is targeted at the needs of our priority populations. In doing so, CCBHC will enable Iowa HHS to ensure that people with SMI, youth with SED, people with significant SUD, pregnant and parenting women, veterans, adolescents with depression and/or SUD, and historically underserved minority communities can access high quality services. Iowa HHS will collaborate with potential CCBHCs and other state-level partners to ensure consistent, accurate, and timely collection, monitoring, and interpretation of required performance measures. The Iowa Behavioral Health Reporting System (IBHRS) will act as the primary information infrastructure for the BH data needed to report measures.

Summary: Built on the foundation of existing suicide prevention efforts, the Community Based Youth Suicide Prevention in Iowa Project (CBYSP Iowa) will enhance and expand suicide prevention, intervention, and postvention strategies and services for Iowa youth who are 10 to 24 years old. CBYSP Iowa will increase the implementation, at the local level, of evidence-based practices for screening, assessing, referring to treatment, and providing follow-up care. Number and Populations to be Served: CBYSP Iowa will serve Iowa's 1,039,415 youth and transition aged youth (TAY) 10 to 24 years old, paying special attention to young people who face discrimination because of their gender, race and sexual orientation. In Iowa, suicide is the ninth leading cause of death among citizens of all ages but is the third leading cause of death for youth 10 to 14 years old and the second leading cause of death for 15-24 year old TAY. CBYSP Iowa will (a) enhance and expand suicide prevention, intervention and postvention strategies and services in three Iowa counties with demonstrated need, and (b) reach all youth through a statewide media campaign that promotes the 988 Suicide and Crisis Lifeline. Additionally, at least 800 providers will receive evidence-based gatekeeper training; at least 400 providers will participate in the Best Practice in Youth Suicide Prevention Summit; and at least 85% of clinical staff who work with youth will receive evidence-based suicide intervention training. Goal 1. Increase the number of staff of youth-serving organizations able to work with youth at risk of suicide by strengthening the capacity to screen and identify at-risk youth. Objective: At least 800 school staff and other gatekeepers (i.e., childcare professionals, foster parents, juvenile justice staff, and staff from other youth serving organizations) will complete LivingWorks Start or other evidence-based gatekeeper trainings. Objective: Selected CBHOs in three counties of high need will implement suicide screening protocols and procedures and report a statistically significant increase in the number of youth screened for suicide risk and treated and/or referred for services. Goal 2. Increase the capacity of clinical service providers to assess, manage, treat, and provide continuity of care and follow up for youth and TAY at risk of suicide Objective: Build connections across the state and disseminate training opportunities including those offered by NAMI Iowa, CDC guidelines, SAMHSA toolkits, resources such as, AFSP postvention materials, suicide loss support and crisis resource information. Objective: Implement the annual Best Practice in Youth Suicide Prevention Summit to share evidence-based practices. At least 400 providers will participate by the end of the grant. Objective: At least 85% of clinical staff from designated hospitals, mental health and substance use disorder treatment organizations, and other youth serving organizations will attend Assessing and Managing Suicide Risk (AMSR), Collaborative Assessment and Management of Suicidality (CAMS), Counseling on Access to Lethal Means (CALM), ASIST or other IDPH approved evidence-based suicide intervention training. Goal 3. Reduce the number of 10 to 24 year olds attempting or dying by suicide by improving the continuity of care and follow-up and increasing the number of youth/TAY who access and use suicide prevention services through the 988 Suicide and Crisis Lifeline. Objective: Designated hospitals will provide at least 100 referrals to the Your Life Iowa (YLI) Follow-up Coordinator for follow-up care for youth at risk of suicide. Objective: CBYSP Iowa will launch a statewide youth suicide prevention awareness campaign to promote the 988 Suicide and Crisis Lifeline and increase the use of the 988 Suicide and Crisis Lifeline via call, text, or chat by 10 to 24 year olds by at least 10

Our proposed MHAT Project will provide mental health (MH) awareness training in Sioux City Iowa, a geographic area of approximately 82,560 residents and roughly 60 square miles that sits on a tri-state border with South Dakota and Nebraska. While classified as one of the “10 Most Livable Small Cities in the U.S,” not all populations in Sioux City enjoy a good quality of life and wellbeing, particularly those affected by adverse mental health conditions. For example, the most recent survey found that while representing only 2% of Sioux City’s population, 47% of Sioux City’s homeless were Native American. Mental health, domestic violence and substance abuse are the major factors contributing to homelessness. Moreover, local Native Americans have the highest percent of poverty, a whopping 40% and a major contributor to adverse mental health conditions (Community Health Needs Assessment 2019-2021 for the Siouxland Community). Sioux City suicide investigations have almost quadrupled in 2020 as there were 18 suicides reported in 2020, compared to just 5 in 2019 (1.20.21 AP news). Our population of focus is comprised of individuals of all ages exhibiting signs or symptoms of mental illness to include school-aged children, veterans, children with a serious emotional disturbance (SED), adults with a serious mental illness (SMI), individuals with co-occurring disorders, and the general public. To increase behavioral health equity, our project will place a heavy emphasis on inclusion of Native American youth and adults among our population of focus. Over our 5-year MHAT project, we will train 1600 individuals who interact with and encounter these individuals who may be experiencing or exhibiting symptoms of a mental disorder. Our proposed MH First Aiders will include a broad and diverse representation of individuals such as school personnel, emergency first responders, law enforcement, veterans, armed services members and their families, and families, caregivers, and service providers. Along with our many partners, our MHAT Project will be implemented by the University of Iowa’s Native Center for Behavioral Health, a research center at the University’s College of Public Health committed to developing programs to support the Native and non-Native behavioral health workforce. We will apply our mental health awareness knowledge and skills, including how to interact in a more culturally responsive manner with Native Americans affected by a mental health disorder. Aligned with recommendations from the Community Health Needs Assessment referenced above, we are proposing to implement Mental Health First Aid (MHFA including the youth version YMHFA). Also, to maximize exposure, we will also implement QPR (Question, Persuade, and Refer), and ASIST (Applied Suicide Intervention Skills Training). This approach will operationalize our project’s primary goal to: Increase MH awareness and safe and appropriate responses among individuals who interact and come into contact with persons who may be experiencing or exhibiting symptoms of a mental disorder.

Project Prepare, Engage, Assess, Respond, Link, Sustain (PEARLS) is a partnership between the University of Iowa, the Iowa City Community School District (ICCSD), and local community, government, and mental health agencies, to provide mental health awareness training (MHAT) to K-12 community stakeholders in Johnson County and improve linkages to care for Iowa’s school-aged youth (ages 5-18). Project PEARLS will focus on 9 schools with high rates of racial/ethnic minority (REM) students and free and reduced lunch (FRL) recipients and train 1000 K-12 community stakeholders over five years. These populations to be served include: (a) 700 K-12 school personnel (600 of whom are teachers) in target schools serving 4,818 K-12 students, (b) 200 parents/guardians/caregivers of children with serious mental illness (SMI) and/or social emotional disturbances (SED), (c) 50 before- and after-school care providers, and (d) 50 law enforcement personnel. Project PEARLS will integrate and manualize 4 evidence-based practices (EBPs) to guide our intervention, including: 1) SAMHSA’s Ready, Set, Go, Review; 2) Psychological First Aid; 3) Cultural Competency & Humility Best Practices; and 4) Mindfulness-based Stress Reduction. The empirically-supported Framework for Reporting Adaptations and Modifications-Enhanced (FRAME, Sirman, Baumann, & Miller, 2019) will inform content- and context-based adaptations across these four EBPs. Our resultant curriculum will guide the delivery of 50 training sessions across stakeholder groups. Project PEARLS goals reflect ICCSD and community needs, and include: 1) establish a coalition of community stakeholders to address the mental health needs of school-aged youth; 2) adapt, integrate, and implement the 4 evidence-based frameworks to address the mental health needs of school-aged youth; 3) increase mental health screening and linkages to care for school-aged youth; and 4) train community stakeholders to (a) recognize signs and symptoms of SMI and SED, (b) implement crisis de-escalation and stabilization techniques, (c) refer and track youth in need of mental health services, and (d) practice self-care strategies for providing mental health services. Measurable objectives include: 1) forming a Community Coalition of K-12 stakeholders to facilitate needs assessment, community engagement and recruitment, 2) establishing a pipeline for referral, linkages to care, and follow up of K-12 students with SMI and SED 3) integrating the 4 EBPs into a streamlined curriculum with FRAME as an implementation science framework, 4) launching Project PEARLS website and social media to aid in recruitment and knowledge dissemination, 5) finalizing a responsive referral network of community mental health providers for K-12 students with SMI and SED; 6) finalizing a formal, confidential, and developmentally-appropriate referral and follow-up process to screen K-12 students and provide linkages to community mental health providers, and 7) training and assessing a) 700 school personnel, with 100-year 1, 150-year 2, 175-year 3, 175- year 4, and 100-year 5, b) 200 parents/guardians/caregivers, with 50-years 2-5; c) 50 before- and after-school providers, with 25 each-years 3-4, and d) 50 law enforcement personnel, with 25 each-years 3-4.