IN Discretionary Funding Fiscal Year 2020

Centerstone COVID-19 Emergency Response for Suicide Prevention in Indiana (IN-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 the geographic area comprising 26 Southern Indiana counties. IN-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. IN-ERSP’s focus population demographics are expected to mirror those of the catchment area, with 50% male, 50% female, 92% white, 3% African American, 3% Hispanic/Latino individuals ages 25+. IN-ERSP will place special emphasis on supporting victims of domestic violence who face suicide risk factors (e.g., stress, anxiety, trauma) exacerbated by current conditions (e.g., stay-at-home orders). Prior to the pandemic, suicide rates among the focus population far exceeded the nation (16.5/100,000 vs. 14.5); rates are expected to rise as a result of the COVID-19 crisis. For example, local Indiana service providers have seen a 48% increase in suicide calls and a 116% increase in crisis text contacts, many regarding domestic abuse. In response to the COVID-19 pandemic and related behavioral health needs, IN-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. Care transition/coordination will also be provided for clients of the Stride Center, Centerstone’s crisis diversion facility. IN-ERSP will assess clients’ risk level and develop a crisis management plan 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. IN-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). IN-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. IN-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. IN-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.

The purpose of this program is to provide crisis intervention services, mental and substance use disorder treatment, and other related recovery supports for children and adults impacted by the COVID-19 pandemic. Indiana's COVID-19 project will improve systems to better serve individuals with Serious Mental Illness (SMI) and/or Substance Use Disorder who are experiencing new and/or exacerbated emotional distress due to the current national crisis of COVID-19. Indiana expects that many Hoosiers will struggle with increases in depression, anxiety, trauma, and grief. There is also an anticipated increase in maladaptive coping skills, e.g., increased substance misuse, gambling, social withdrawal (not due to social distancing), anhedonia, making care-takers less likely to provide for themselves and their immediate family members thus lives will be adversely impacted for individuals and families. The purpose of this program is to provide crisis intervention services, mental and substance use disorder treatment, and other related recovery supports for children and adults impacted by the COVID-19 pandemic and reach their highest level of physical and emotional well-being through evidence-based treatment. Additionally, the program will also focus on meeting the needs of individuals with mental disorders that are less severe than serious mental illness, including those in the healthcare profession. The project will establish a connection between the community mental health center (CMHC) to allow for immediate evidence based practices utilizing telehealth interventions and Face to Face when warranted - and linkage to treatment as needed. Indiana's COVID-19 project will serve individuals who have existing MH and SUD conditions that cannot be met as easily due to the pandemic. The goal is to insure there is not an influx to emergency room visits, defer persons from inpatient stays, by triaging and provide coping skills for those with less severe than a serious mental illness. These numbers are based on the level of intensity of services to meet project goals for individuals with serious mental illness who are under court order for treatment. The goals and measurable objectives for this project are: - Increase consumer adherence to treatment by identifying barriers to treatment and improving treatment outcomes. - Decrease number of individuals in emergency departments - Decrease the number of referrals to inpatient psychiatric stays for individuals with SMI. - Decrease the number of referrals to residential addictions programs - Increase linkage to community resources to improve social determinants of health. - By the end of the first grant year, program participants will receive telehealth services to assist them in coping with the pandemic and staying in their homes - By the end of the first grant year, program participants will show a 25% reduction in inpatient referrals for SMI and/or SUD treatment. - By the end of the grant year, 50% of program participants will have no new psychiatric hospitalizations.

The proposed project, titled Undergraduate Training in Addictions Intervention, will implement a two-tiered approach intended to expand practitioner education, help relieve the practitioner shortage, increase treatment availability, and reduce substance use disorders (SUD) treatment stigma by moving SUD training further into the educational mainstream. Nearly 92% of those with SUDs in the United States fail to receive treatment, a situation made worse by an acute shortage of qualified mental health and SUD practitioners. Prevention Insights (PI), a translational research organization at Indiana University, Bloomington, IN, proposes to develop a 45-hour educational curriculum for a new online course, Principles of Substance Abuse Assessment and Treatment, designed to educate undergraduate students in screening, brief intervention, and referral to treatment (SBIRT) as well as principles of SUD assessment, and treatment. Second, this class will serve as the capstone course of a newly proposed 12-credit certificate, the Online Undergraduate Certificate Program in Addiction Intervention. Completion of the certificate will also qualify students for the Certificate in Addiction Intervention, Practitioner Rank from the Indiana Credentialing Association on Alcohol & Drug Abuse (ICAADA). Anyone who enrolls at Indiana University will be eligible to complete this certification or any of the constituent courses. Subject matter experts and educational professionals at PI will complete the following goals and objectives in the course of this project: (1) Create a 12-credit-hour Online Undergraduate Certificate Program in Addiction Intervention; (1a) Create a new 45-contact-hour online course, Principles of Substance Abuse Assessment and Treatment; (1b) Prepare and adapt three existing undergraduate courses to meet Quality Matters standards for online education; (2) Gain approval for the certificate across the university; (2a) Prepare all justification documents for review; (2b) Promote the new certificate and courses; (3) Implement the new certificate and courses; (3a) Formally identify faculty who are experts to teach courses; (3b) Offer each course at least once annually, with the capstone course offered twice annually; (4) Conduct evaluations of the certificate and course; (4a) Conduct pre-test surveys of the capstone class; (4b) Conduct post-test surveys of the capstone class; (4c) Conduct an overall evaluation of the certificate program; (5) User evaluation data to modify the program; (5a) Prepare a revised curriculum for the capstone class; (5b) Implement the revised class in the second year of the project; (6) Develop sustainability of the certificate and capstone class; (6a) Gain approval from the PI Executive Director to support staffing of the program; (6b) Gain approval for the program content from the Indiana Commission for Higher Education. The number of people served annually by the proposed course and certificate will vary based on enrollment. However, the potential exists to serve any number Indiana University's nearly 88,000 undergraduates.

Indiana University Health – South Central Region provides Emergency Medical Services in Monroe, Lawrence, and Orange Counties. Through the proposed EMS Training Project, we will provide innovative EMS training opportunities to address the paramedic shortage, particularly in rural areas of our catchment area, including Paoli. SAMHSA funds will support the establishment of three local state-of-the-art training sites, the purchase of EMS training equipment, and training on mental and substance use disorders and the use of naloxone in opioid overdose emergency situations. Project Name: Indiana University Health – South Central Region EMS Training Program Population to be served: The estimated combined population for Monroe, Lawrence, and Orange Counties is 212,074. These counties have experienced a spike in need for EMS services as a result of an ageing population, the opioid crisis, and the fact that Indiana ranks 41st out of the 50 states in health. These issues are especially prevalent in rural service areas. Strategies/interventions: Through the proposed project, we will address the paramedic shortage using Zoom Room, a cutting-edge software-based training room system. We will recruit and train 10 to 15 new paramedics during the grant period, implementing all SAMHSA required grant activities. Project Goals and Measurable Objectives: Through the proposed 12-month project, we will expand EMS training, resulting in increased EMS staff serving in our highest need locations. Measurable objectives related to this goal include establishing two new EMS training sites using Zoom Room technology and EMS training equipment, we will train 10 – 15 new paramedics and improve outcomes for residents experiencing opioid overdose. 10-15 class participants will be trained on the selected curriculum addressing mental health and substance use disorders, including Naloxone administration. Furthermore, SCR will purchase 20 Naloxone Kits to be distributed to all EMS providers in the South Central Region. Finally, we will improve EMS service response time for residents of rural Paoli by making necessary renovations to the ambulance garage at the IU Health EMS in Paoli.

Focused training would be offered in the following areas: state certified paramedic course, existing personnel to receive instruction certification, training equipment, and diversity training for staff. The requested grant funding would specifically support the following: (1) Paramedic level training course and certification for five staff members. This ensures the highest level of 911 services available in the county for all employees. (2) Purchase training equipment and supplies required by the State of Indiana to become a state certified training institution; and (3) Purchase virtual training software and hardware to enable the facility to host hybrid training courses Parke County has a population of 17,334 and receives nearly two million visitors annually due to its two State Parks, outdoor recreation venues, and festival events. Our county is also home to a growing population of over 1,500 Amish citizens. Our county does not have a hospital, emergency care facility, or assisted living facility. Paramedic level trained staff is crucial for our residents and visitors. Over 56% of the county population is age 44 and older with 39% of that being 55 and older (Purdue University Center for Regional Development). All the aforementioned would benefit from enhanced skill training, increase the pool of state certified personnel, and provide opportunity for our volunteer first responders and firefighters. As a county owned 911 service, our budget doesn’t allow for training new personnel, maintenance of existing certifications, or upskilling our current staff. Today, the responsibility of this expense is falling on the individuals serving the residents and visitors of our community. We experience difficulties recruiting new employees due to pay level and limited training opportunities. We do our best to be creative by partnering with other ground services, air services, and hospitals to provide some training for our employees. Our ambulance service has a training space available but we’ve been unable to fully utilize due to lack of funding for training and equipment. In 2019 our agency responded to 20 overdose related calls, 4 suicide attempts, and 31 mental health disorders. The patients from those calls would have benefited from having responders with narcan training, de-escalation training, and mental health first aid training. These courses are all offered as a portion of the classes that we will to offer all responders who attend. The narcan training could have potentially saved the life of a young overdose patient in our county in early 2019. Due to the response time of the ambulance, an overdose victim did not get their first dose of narcan for 14 minutes after they were found unresponsive by family. First responders were on scene within 5 minutes but lacked the proper training to carry or utilize the needed medication that could have saved a patient’s life.

The “Suicide Prevention Navigators Coordinating Care for Suicidal Crisis and Domestic Violence Victims” project involves embedding a network of Suicide Obviation and Support Navigators (SOS navigators) in ten emergency departments (EDs) throughout Northeast Indiana and connecting (as support and training resources) to our inpatient psychiatric facility and domestic violence organizations to provide screenings, coordination of care, and at elbow support for those recently experiencing suicidal crisis and/or domestic violence. Using a caring contacts intervention format to guide our intervention strategy, four SOS navigators will follow up within 48 hours with those who have experienced a suicidal crisis and have been recently discharged from our network of 10 emergency departments in Northeast Indiana (NEI) and our inpatient treatment facility (PBH). They will also provide support (including referrals to insurance navigators) for the client to see a mental health service provider within seven days of discharge. We will also employ a project director and outreach educator to build, connect, and educate a comprehensive suicide prevention network in our NEI community. Our goals are: 1) to reduce suicides in NEI and provide support, screenings, and outreach to those who are experiencing suicidal crisis or domestic violence during the COVID-19 pandemic and 2) provide education to the members of the community (both clinical and other support organizations) who interact with those who may be in crisis. This will include training on evidence based practices, such as screening for depression, suicidality, and domestic violence using validated tools (i.e., Patient Health Questionnaire 9, Columbia–Suicide Severity Rating Scale, and Partner Violence Scale), client safety strategies (i.e., Counseling on Access to Lethal Means (CALM) and Safety Planning Interventions (SPI) with clients to help ensure safety after discharge), and Question, Persuade, Refer (QPR) training for the SOS navigators and community members to help them learn to effectively identify and refer those who might be experiencing crisis. The navigators and coordinator will also identify support resources for clients and serve as bridges between the client and health, mental health, and domestic violence organizations (these will be counted as project outcomes). We project that we will enroll 50 clients in month 3 and approximately 100 clients per month beginning in month 4 (estimated 950 total clients within entire 16-month grant period), with whom the SOS navigators will maintain contact for 6 months to 1 year. Additionally, we intend to conduct at least 16 community trainings on suicide prevention for adults from involved organizations (approximately 30 per session), which may be a mix of online and face-to-face trainings, depending on COVID-19 gathering restrictions.

Nurses' Substance Use Education Through a Massive Open Online Course (NSUE-MOOC) is designed to mainstream substance use (SU) education by reaching Purdue University, West Lafayette, School of Nursing (PSON) students, as well as those students in collaborating SONs from across the country and representing a range of educational levels. Utilizing Purdue University technology strengths, the PSON will create a MOOC focusing on substance use, that will provide comprehensive, adaptable, and sustainable education to nurses across curricula - both undergraduate and graduate students. In response to the funding announcement, our goals are: 1) to mainstream substance use (SU) content and develop high quality, comprehensive, SU education modules (a continuum of modules, from novice to advanced practitioner) that nurse educators can integrate into their existing curricula, including educational-level specific content (i.e., associate degree [ADN], baccalaureate [BSN/BS], advanced practice [NP and doctor of nursing practice/DNP]); and 2) to increase the composition (ADN to NP/DNP) and number of nurses learning substance-use-specific content. Faculty from Purdue and the partnering schools will select modules from the MOOC to incorporate into their existing curricula for course credit or as a supplemental learning opportunity. Through these modules and with our collaborating institutions, we will prepare a professional nursing workforce who is ready to provide informed substance-use care. To accomplish this, our objectives are: 1) to incorporate evidence-based substance-use content and trauma-informed principles of care into the undergraduate and graduate modules, including content related to impaired nurses and colleagues which balances threats to public safety with compassionate care; 2) to decrease stigma toward patient, peers, and colleagues in the nursing workforce by increasing the number of student nurses receiving an evidence-based, substance-use education based on our curricular modules. The module content will reflect trauma-informed and social contexts, including social determinants of health, as well as neurobiological changes related to substance use (alcohol, marijuana, stimulants and opioids); 3) to partner with experts in SU and technological innovations to build pedagogically sound, engaging, high-quality modules that are available within the NSUE-MOOC and that may be integrated into a variety of nursing programs; 4) to capture appropriate utility metrics, including PSON student and faculty feedback from pilot (Year 1) and ongoing use (Year 2), editing the MOOC content accordingly; and 5) to forward final reports to licensure and certification bodies: the National Council of State Boards of Nursing and the American Nurses Credentialing Center. We anticipate that the use of technology will allow our modules to reach our local PSON as well as our collaborating schools to mainstream SU education. In this way, graduating nurses will be more informed on the assessment and treatment principles of people who struggle with SU, and thus, provide compassionate bedside and advanced care to individuals who have SU issues.

Adult & Child Mental Health Center proposes to expand on its current homelessness outreach and treatment services through the implementation of an Assertive Community Treatment (ACT) program. The ACT Team will focus exclusively on consumers with severe mental illness who are homeless by working alongside community homeless outreach providers to proactively engage and serve this population. The purpose of this project is to establish and maintain an ACT program for individuals with a serious mental illness (SMI). A&C expects this program will improve behavioral health outcomes for individuals by reducing rates of hospitalization, mortality, substance use, homelessness, and involvement with the criminal justice system. Activities of this program include but are not limited to the following: comprehensive assessment, crisis assessment and intervention illness management and recovery skills, individual supportive therapy, substance use disorder treatment, peer and family support, employment support services, assistance with activities of daily living, connection and intervention with support networks and recovery support services, care management and case coordination; and psychotropic medication for treatment of SMI and medication for other medical conditions prescription, administration, and monitoring. The ACT Team will serve 100 individuals annually for a project total of 200 clients. Of those consumers experiencing homelessness in the two years preceding ACT enrollment, 90% will be residing in permanent housing after two years of ACT services. ACT staff will provide intensive engagement, outreach, and services to enrolled consumers, as evidenced by consumers receiving on average 3 face to face contacts and 90 minutes of face to face contact per week. Of those consumers experiencing incarceration or arrest in the two years preceding ACT enrollment, 50% will experience a reduction in arrests for new charges after two years of ACT services. ACT substance abuse specialist will develop stage-wise dual disorders programming by the end of the second quarter of year one. Of those consumers experiencing a psychiatric hospitalization in the two years preceding ACT enrollment, 70% will experience a reduction in psychiatric hospitalizations after two years of ACT services.

Project Abstract Aspire’s project, “Expanding Assets and Resources for the Homeless in Central Indiana”, will expand and enhance access to mental health, substance abuse, employment and housing supports. Population to Be Served consists of residents of Boone, Hamilton, Madison, Hanock, and Hendricks Counties, focusing on homeless individuals with serious mental illness, serious emotional disturbance, or co-occurring disorders. Strategies/Interventions: Aspire will enhance and expand health, employment, and housing services to homeless individuals in the target population through a combination of outreach efforts, integrative healthcare, and utilization of additional housing assistance funds. By utilizing a “no wrong door” methodology, Aspire will increase the comprehensive quality and convenience of services clients will receive. Project staff and additional care providers through Aspire Indiana will follow industry standards, and utilize a variety EBPs in the delivery of primary health, mental health, substance abuse, employment and permanent housing assistance and services. Goals and Objectives: Goal 1: Improve identification of target population through comprehensive assessments. Objective 1.1: Locate and identify 100 individuals who are chronically homeless. Have a 90% referral rate for assessment. Objective 1.2: Have an 90% assessment completion rate of clients referred for assessment. Goal 2: Connect eligible participants with appropriate services, based on comprehensive assessments results. Objective 2.1: Connect 75 individuals with housing support services, and other services as needed. Objective 2.2: Successfully connect 60 individuals with permanent housing annually. Objective 2.3: Have an 80% success rate in maintaining permanent housing at the end of each calendar year. Goal 3: Improve the quality of life of participants through engagement in integrated care services. Objective 3.1: Connect 60 individuals with primary care services and measure improvements in baseline health indicators. Objective 3.2: Connect 60 individuals with comprehensive behavioral health services and measure improvements in behavioral health through improvements in (Adult Needs and Strengths Assessment) ANSA scores. Objective 3.3: Connect 20 individuals with addictions services and peer recovery services and achieve reduction or abstinence from substance use in 50% of participants. Objective 3.4: Enroll 60 individuals in benefits through the Entitlement Specialist. Objective 3.5: Engage 60 individuals in employment services, increasing household income in 50% of participants. Number served: Year 1 – 100, Year 2 – 100, Year 3 – 100, Year 4 - 100, Year 5 - 100, Total: 500

Centerstone's Certified Community Behavioral Health Clinic (C-CCBHC) will support continued/expanded implementation of the agency’s CCBHC in Bloomington, Indiana, improving access to/quality of community behavioral health services for individuals with serious mental illness (SMI), substance use disorders (SUD), opioid use disorders (OUD), co-occurring disorders (COD), and/or youth with serious emotional disturbance (SED). C-CCBHC will serve 2,000 unduplicated clients from among the 6,100 served at the clinic yearly (Yrs 1-2: 1,000/yr). C-CCBHC’s target population is expected to mirror those of the catchment area, comprising Bartholomew, Brown, Greene Lawrence, Monroe, Morgan, and Owen counties in Indiana. Children/adolescents will comprise 51% male, 49% female, 86% white, 2% African American, and 6% Hispanic/Latino individuals; adults will comprise 49% male, 51% female, 90% white, 2% African American, and 3% Hispanic/Latino individuals. Of the catchment area’s population of 409,000, nearly 17,125 adults have SMI; 83% did not receive mental health services. Roughly 24,060 catchment area adults have SUD; 12,046, COD; and 2,605, OUD. Of adults reporting illicit drug use, 29,112 needed, but did not receive treatment. Roughly 8,349 catchment area children/adolescents meet criteria for SED, and 1,008 (ages 12-17) have SUD. An expected 8,300 area Vets have a mental health/SUD diagnosis, including 2,615 in rural areas, and about 1,250 have SMI. About 374 area Veterans with SMI are expected to also have PTSD. Since 2017, there have been 273 confirmed Hepatitis A cases. From 2016-2018, there were 168 Hepatitis B and 1,561 Hepatitis C catchment area cases. Roughly 9.3% of the area’s 433 persons with HIV were co-infected with Hepatitis C; 54% of those also reported injection drug use. Immediately upon award, C-CCBHC will provide an array of integrated primary/behavioral health care services (e.g., crisis care; mental health screening, assessment, and diagnosis; primary care screening and monitoring of key health indicators; HIV/Viral Hepatitis screening; integrated treatment planning; Medication Assisted Treatment and medication management; and telehealth). Medical detoxification and vaccination services will be provided by project DCOs. C-CCBHC’s evidence-based interventions are numerous and include Cognitive Behavioral Therapy, Motivational Interviewing, Assertive Community treatment, Illness Management and Recovery, Integrated Dual Disorder Treatment, and more. C-CCBHC will accomplish the following goals: 1) Continue delivery of comprehensive community-based mental and substance use disorder services for the target population, meeting all CCBHC criteria; 2) Enhance infrastructure/capacity for a full continuum of coordinated care; 3) Ensure access to/availability of timely services for the target population; 4) Improve health status and outcomes for C-CCBHC consumers engaged in treatment; and 5) Apply a CQI approach to drive outcome improvement and ensure ongoing service delivery. To support these goals, C-CCBHC will achieve the following measurable objectives: Decrease mental health symptomatology by 45%; Decrease substance use by 45%; Achieve 50% reported compliance with medication; Deliver personalized treatment plans for 100%; and Achieve 80% consumer/family reported satisfaction with their experience of care. Key C-CCBHC strategies include expanding/enhancing access/services; convening the exiting Advisory Work Group; collaborating with community providers to promote whole-person wellness and recovery; utilizing an experienced evaluation team; and applying a continuous quality improvement approach to drive improvements and sustainability.