ID Discretionary Funding Fiscal Year 2020

ABSTRACT Benewah Medical Center dba Marimn Health is requesting $498,958 in funding under the SAMHSA Emergency COVID-10 FOA FG-20-006 CFDA 93.665. The purpose of the Marimn Health ER COVID-19 project is to enhance existing, or proposed, Substance Use Disorder (SUD) and less than severe mental health (< SMI) behavioral health services for those impacted by the COVID-19 crisis who may benefit from behavioral health services. The existing Marimn Health Comprehensive Plan of evidence-based Mental and SUD treatment services will be revised to accommodate COVID-19 health restrictions which will include alternative avenues of service provision such as telehealth. Behavioral Health has screening and assessment tools in place which will also be adapted to accommodate COVID-19 health restrictions. Adapted assessments will be utilized to develop appropriate treatment plans. The existing EBP treatment services must also be modified to serve the population of focus. Due to health restrictions, group sessions are no longer in place. Counselors are currently communicating with clients by phone or through the internet. Medication management and Medicated Assisted Treatment remain in place. Outreach services will be enhanced also to reflect the health restrictions to safely communicate with members of the population of focus. The addition of a care manager and a behavioral health counselor will assist with this implementation. A crisis team is in place and the addition of a 24-hour hotline will enhance access to services. Marimn Health plans to provide internet access and tablets to those who may benefit to increase and retain access to services. The addition of a behavioral health counselor and a care manager will increase access to services for the population of focus. The proposal is designed so that 70% of funding is used to provide direct services to those with Substance Use Disorders; 10% of direct service funding is dedicated to assist healthcare practitioners with mental disorders (less severe than SMI) and 20% of direct service funding is dedicated to all other mental disorders less severe than SMI. A project director will oversee the project and a data analyst will provide monitoring and quality improvement measures for the project. Software upgrades will enhance client tracking, program quality improvement, and reporting requirements. A portion of the funding request will offset the cost of non-billable telehealth behavioral health direct services which, at the time of this proposal, are non-billable. Implementation of this proposal will result in enhanced access to behavioral health services. In order to serve clients who are impacted by the COVID-19 national crisis and may be diagnosed with Substance Use Disorder (SUD) or less than severe mental illness (< SMI), Marimn Health Behavioral Health proposes to enhance services to meet this need.

Comparable to the rest of the nation, Idaho is combating the COVID-19 pandemic, with the number of contaminated Idahoans rising significantly daily. As these numbers increase and the economy simultaneously crashes, Idaho is realizing a subsequent upsurge in the need for crisis and on-going behavioral health supports and treatment. Additionally, hospital beds currently used to serve individuals with psychiatric needs are now needed for COVID-19 patients, creating a gap in services for Seriously Mentally Ill (SMI) population. The Idaho Department of Health and Welfare, Division of Behavioral Health (DBH) intends to help mitigate this gap by providing an alternative for this population. DBH plans to implement a 3-pronged approach to bring needed resources to Idahoans during this time of crisis: Emergency Department Behavioral Health Diversion and Triage: Idaho will stand up a Diversion and Triage unit to provide emergency services to patients with psychiatric conditions, but do not have critical medical health needs. This includes the establishment and utilization of a COVID19 Behavioral Health Distress Line, emergency department diversion and triage, and utilization of crisis centers to provide subacute care for patients not requiring acute inpatient psychiatric hospitalization. Access to Substance Use Disorder (SUD) Treatment: Idahoans uninsured due to the economic devastation resulting from COVID-19 will be provided access to SUD treatment. Target population includes individuals with SUD and those co-occurring individuals with either SMI or less than SMI symptoms and who fall between 138-200% of FPG. Services include residential and out-patient treatment, and recovery support services. Access Behavioral Health Services for Professionals: Professionals of all types currently on the front lines of the COVID-19 crisis, including medical professionals, as well as other behavioral health providers, are often in need of services themselves. Those needing assistance will be offered five (5) free sessions of evidence-based counseling or assistance in accessing services if already insured.

SAMHSA Emergency Grants to Address Mental and Substance Use Disorders During COVID-19 Nez Perce Tribe Abstract Summary Funding assistance is requested from the SAMHSA Emergency COVID-19 program to help the Nez Perce Tribe conduct an effective public health emergency response to COVID-19 on the 1,208 sq. mile Nez Perce Reservation in north central Idaho. SAMHSA funding will be used for the Nez Perce Tribe Health Authority, Nimiipuu Health and its Behavioral Health Department, to contract with qualified public health professionals over one year to assist the two Nimiipuu Health centers in identification, treatment, and monitoring of the COVID-19 epidemic among the Tribe's 3,650 members and 4,780 Nimiipuu Health clients who are engaged in or at risk of SUD and/or co-occurring mental disorders. Funding will help cover an additional 25% increase in hours needed by the Nimiipuu Health Behavioral Health Director in addressing the pandemic and will pay for the department to hire a data specialist at 50% full time employment to monitor data regarding behavioral health cases impacted by the pandemic. Direct services will enable Nimiipuu Health Behavioral Health to obtain sobriety housing for the equivalent of 12 individuals in recover from SUD to obtain sobriety housing for 12 months and for 12 clients with SUD or co-occurring mental health disorders to obtain 30-45 in-patient residential treatment services as needed. Additionally, funding will enable Nimiipuu Health Behavioral Health to contract with outside qualified mental health professionals to provide up to 750 hours in contract services to help alleviate the increased demand for mental health evaluations and counseling services for Nimiipuu Health Behavioral Health clients, as well as 80 hours of contract counseling as needed to help medical staff cope with extreme stress resulting from the pandemic. Our funding request is in the amount of $453,467.

The vision of the Terry Reilly Health Services (TRHS) COVID-19 and Suicide Prevention is to increase the capacity at TRHS to prevent, intervene and treat our patients 25 years of age and older who have suicide ideation and/or who have attempted suicide and are being affected by COVID-19 by deploying the Zero Suicide framework of care. Specific goals for the project include the following: Goals: • TRHS will create a leadership-driven, safety-oriented culture at committed to dramatically reducing suicide among people under our care • TRHS will develop a competent, confident, and caring workforce through training of staff • TRHS will systemically identify and assess suicide risk among people receiving healthcare from us • TRHS will ensure every individual under our care has a pathway to care that is both timely and adequate to meet his or her needs • TRHS will use effective, evidence-based treatments that directly target suicidal thoughts and behaviors • TRHS will provide continuous contact and support when patients are transitioning care into or out of TRHS • TRHS will apply data-driven, quality improvement approach to inform system changes that will lead to improved patient outcomes and better care for those at risk Specific activities include • Develop and implement a plan for rapid follow-up of adults who have attempted suicide or experienced a suicidal crisis after discharge from emergency departments and inpatient psychiatric facilities. This includes directly linking up with selected emergency departments and inpatient psychiatric facilities to ensure care transition and care coordination services. • Establish follow-up and care transition protocols to help ensure patient safety, especially among high risk adults in health or behavioral health care settings who have attempted suicide or experienced a suicidal crisis, including those with serious mental illnesses and/or substance use disorder(s). • Provide suicide prevention training to community and clinical service providers and systems serving adults at risk. • Work across state and community departments and systems in order to implement comprehensive suicide prevention. • Provide suicide screening and assessment and appropriate clinical treatment services required as a result of the assessment. • Provide community recovery supports to assist individuals who have attempted or are at risk for attempting suicide, including supports for impacted household members. • Services will include telehealth options given the current pandemic situation. These services will be available both by telephone only and by audio-visual service provision. • Provide enhanced services for victims of domestic violence and their dependents including a safe place to stay in the event that individuals are unable to remain safely in the home setting.

The Idaho WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) Medical Education Program, through the University of Idaho proposes to leverage funds from the SAMHSA Prac-Ed grant (CFDA 93.243) to design and implement a project titled, ‘Idaho WWAMI SUD Certificate Program.’ The Idaho WWAMI SUD Certificate Program will be a new certificate program established through the North Idaho AHEC (Area Health Education Center) Program (Housed in WWAMI) that will provide SUD-specific medical education to interdisciplinary health professions students throughout Idaho. The primary modality of content development and delivery will be through using the evidence-based ECHO (Extension for Community Healthcare Outcomes) model, complemented by asynchronous session recordings, supplemental media, journal articles, and an 8-hour experiential learning component in a SUDs-related medical environment. The project aims to reach a total of 100 health professions students throughout the lifetime of the project and will remain open to students who seek to obtain a certificate following the conclusion of the project period. All materials will be evaluated and updated responsive to findings of evaluations through implementing a continuous quality improvement process during the project period.

Benewah Medical Center dba Marimn Health is applying for $368,880 in funding under the SAMHSA Grants to Implement Zero Suicide in Health Systems FOA SM-20-015 CFDA 93.243. The Marimn Health Zero Suicide Project is designed to enhance the existing suicide prevention and intervention infrastructure in order to increase the capacity of Marimn Health to fully implement the Zero Suicide Model for the benefit of the community. Funding will provide for the addition of a Care Manager to assist with transitions, a Project Director to oversee the project. The funding will also provide for evaluation of program success. This proposal will support full representation on the Suicide Leadership Team of those impacted by suicide; full implementation of the Zero Suicide Care Management Plan; installation, training and use of valid and reliable screening and tracking measures; staff training on the Zero Suicide Model, implementation of local after-hours crisis line, education and planning with reduction in self-harm; outreach and provision of services to the population of focus which consists of natives, non-natives, veterans, and those diagnosed with serious mental illness (SMI). Marimn is a federally qualified health center and serves all populations. The service area harbors 248,697 residents. Over 7,326 residents consider Marimn their medical home; of those, 3,232 are Native American; 4,094 identify as Non-Native. An estimated 2,427 patients received behavioral health services in 2019 with services provided to 433 patients diagnosed with a mental disorder. The local reservation population of 7,805 contains 748 Veterans. The Marimn Health catchment area contains a very high risk population of adults 25 years of age and above. Area residents consist of Native Americans, Veterans, and those from the rural population of Idaho. It is well known that the American Indian/Alaska Native (AI/AN) population, as well as, the U.S. Veteran population are disparately affected by suicide. The unduplicated number of individuals the project proposes to serve increases over the five year performance period; in year one, 15 individuals served; in year two, 20 individuals; in year three, 20 individuals; and in year four, 20 individuals served. By year five, the number served increases to 25. Over the entire project period 100 individuals will be served.

Benewah Medical Center dba Marimn Health is requesting $250,000 under the SAMHSA Fiscal Year 2020 Tribal Behavioral Health Grant Program (Native Connections) to provide outreach, training, mentoring and referral to Native American youth up to the age of 24 for suicide ideation, substance misuse and mental health to enhance existing services. Currently, limited services are available to youth. They mostly consist of post-vention activities for the young-adult age group returning from in-treatment or for those returning home from incarceration. Activities specific to youth are the Healing of the Canoe curriculum which was implemented into the Coeur d’Alene Tribal School last year, serving 25 pre-teens; and individual referral and counseling. After a recent completed suicide by a tribal youth, behavioral health counselors were present on-site at schools to provide crisis intervention counseling to staff and students. Cognitive Behavioral Intervention for Trauma in Schools (CBITS) is scheduled for implementation in 2020. The Marimn Youth Project is designed to enhance existing youth services through outreach, educational and referral activities to schools, youth programs, family and community members. Marimn Health proposes hiring five Healthy Lifestyle Coaches to provide training, education and mentoring services to youth within these various venues. Marimn Health has strong community support through the Tribal Collaboration Committee which consists of concerned tribal entities, elders and staff from youth-serving agencies. Marimn Health has been contacted concerning the provision of services of this nature by the Coeur d’Alene Tribal School, Lakeside School District, Native Services Boys and Girls Club, Indian Child Welfare Program (ICWP), and Coeur d’Alene Tribal Social Services. These inter-agency partners will collaborate to revise and update inter-agency policies regarding the required policy enhancements to close service gaps for those youth who display high risk behaviors. The goal of this program is to prevent suicide, prevent substance misuse, reduce the impact of trauma and promote mental health. The infrastructure is in place at Marimn Health to provide behavioral health services which address substance use disorder, mental health, outpatient medically assisted treatment, referral to in-patient as needed, and related information and training for suicide prevention. Marimn Health offers Question Persuade Refer (QPR) Gatekeeper training to the community, and is initiating Trauma Informed Care Training in 2020 for the work force and community. The clinic is well positioned to provide the activities required under the Native Connections grant.

The Idaho Lives Project (ILP), a program of the Idaho State Department of Education, serves Idaho's youth (to age 24) by building resiliency and well-being, creating connectedness and training to intervene with suicidal ideation, and providing services to support youth, families and schools. Through activities targeting youth, ILP will affect all ages of Idahoans with the intent to eradicate suicide in the state. Though it will require effort from all stakeholders in Idaho to accomplish Zero Suicide, with the 2019 Garrett Lee Smith Grant, ILP will provide opportunities for schools to build connectedness and resilience and to ensure youth receive the support they need by adding the Sources of Strength program. The Project will provide for behavioral health clinicians to assess, refer, and provide follow-up care for youth with suicide ideation / attempts, especially in rural areas which may lack access to services, and will provide best-practice postvention support to schools, if needed. Considering that research show young adult attempters benefit from peer-to-peer groups, the behavioral health clinicians will create and co-lead groups for young adult attempters. Suicide loss survivor packets will be provided to schools and families that suffer loos to suicide. As most mental / medical health providers typically receive little suicide prevention training, ILP will contract with David Rudd, Ph.D. to train licensed professionals in assessing and treating suicidal clients in culturally-appropriate ways. This training also will be provided to college mental / medical health program students. Under Goal 2, adults in the schools and other youth-serving organizations will receive gatekeeper training to be able to intervene with and support youth with suicidal ideation. ILP will also provide support to increase text and chat services at the Idaho Suicide Prevention Hotline (ISPH). As transition times are difficult for youth and young adults, under Goal 3, ILP will collaborate with Sources of Strength school teams, universities and colleges, and post-high school job-serving agencies to provide templates to increase belongingness and connectedness among youth. Early intervention materials will be sent to elementary schools to augment their social and emotional learning programs. Under Goal 4, ILP will build and maintain partnerships with youth-serving organizations, state agencies, suicide prevention organizations, including the ISPF, the Department of Health and Welfare's Suicide Prevention Program, and colleges and universities. ILP will also work with SAMHSA- sponsored Technology Transfer Centers to consult on training programs around the Northwest. Under Goal 5, all programs and activities will be monitored, and data collected to ensure fidelity and efficacy. The number of Idahoans serviced by the activities will be a minimum of 1,000 in year one and a minimum of 7,000 by the end of year five. Data collected from the activities and interventions will be regularly evaluated and shared with SAMHSA as well as with ILP stakeholders and adjustments made through continuous quality improvement to assure continued outcomes toward Zero Suicide.

Idaho is a rural state and its geographical features often create gaps in services or limit access to behavioral health care for youth in our rural and frontier school districts. To address these challenges, the ID-AWARE Project has partnered with three LEAs to build a sustainable framework that will embed mental health clinicians in each district and improve school climate using evidence-based programs and services for students, staff, and communities. The ID-Aware Project will impact approximately 500 people per year and 2050 over the life of the grant. Residents in the three LEAs generally travel greater distances to receive services. They also tend to have lower socioeconomic status, higher poverty rates, may lack comprehensive health care coverage, and experience a shortage of qualified mental health providers. The student-to-counselor ratio averages 400 to 1, which may reduce a school’s ability to intervene and may exacerbate mental health crises. In 2018, Idaho youth ranked 3rd in the nation for suicide deaths per capita. In addition, findings from the Youth Risk Behavior Survey suggest that Idaho’s LGBTQ+ students do not feel safe in their schools or communities. Goal 1 develops a sustainable infrastructure to house a Multi-Tiered Systems of Support to coordinate mental health services for youth in each LEA. Each infrastructure will address the unique needs of the LEA and address Gap 1. Goal 2 expands access to mental health services among youth in the LEAs by embedding trained mental health clinicians in each LEA. The need for mental health clinicians on-site is a known need among the LEAs and addresses Gaps 1 and 2. Family counseling will be a component in the behavioral health setting and in groups for parents with children who have serious mental health issues. Goal 3 trains educators and staff in evidence-based programs that promote wellness and resilience among students and staff by fostering safe and healthy environments within schools, families, and communities. Staff will become competent in strategies to identify and intervene when a student experiences a mental health issue as well as build their professional competency to implement classroom-based practices using trauma-sensitive programs; upstream programs like Sources of Strength Elementary and the Gizmo curriculum; and Sources of Strength for middle/junior and high schools. Ultimately these programs promote a culture of well-being and help seeking for all youth within a school and address Gaps 1, 2, and 3. Community-involvement provides schools with resources and additional layers of support, and the Project will hold meetings and cultivate partnerships in each LEA with parents and community members to collaboratively identify school needs, to find solutions if possible, and to promote connectedness with school, youth and various community groups.

The Clearwater Youth Alliance is applying for the Drug-Free Communities Grant for the community of Orofino, Idaho. The Clearwater Youth Alliance is non-profit community coalition established to foster the wholesome development of youth through substance abuse prevention practices and strategies. It is the intent of the Clearwater Youth Alliance to address the underage drinking problem and marijuana use in Orofino, Idaho.