KS Discretionary Funding Fiscal Year 2020

Our Kansas Behavioral Health Integration into Schools (BHIS) program will focus on improving mental health of children and adolescents affected by tornados and flooring in 2019. These weather events created damaged in 70 of the 105 counties, most of which exist in rural or frontier areas. Our project aims to increase access to school-based behavioral health services through this catchment area, evaluating existing programming through implementation of the Multi-tiered Systems of Support framework (MTSS). To accomplish this, we will import elements from a successful Pennsylvania school-based screening program which combines staff training in evidence-based practices and interventions, access to standardized screening and referral technology, and ongoing technical assistance and implementation support. To implement this program, we will collaborate with Drexel University's Center for Family Intervention Science (CFIS) and software company Medical Decision Logic, Inc (mdlogix). Together, these two teams have built statewide suicide prevention infrastructure across the state of Pennsylvania (70% of counties), with a particular focus on schools. This proposed program is supported by BH-Works, a cloud data and workflow platform that provides tools for screening students, coordinating care, conducting virtual visits, tracking individual outcomes, and analyzing and reporting population data. All elements of this proposed project, including use of BH-Works, will be made available to 20 community mental health centers (CMHCs) from counties affected by these 2019 disasters, as well as schools they serve. We plan to engage with 20 CMHCs, recruiting at least 9 of them to use BH-Works to provide screening and intervention to students on school sites. Since many of the school districts in the catchment area have small student populations, we aim to screen at least 250 students by the end of this 1-year project period. Most of these screenings will be indicated, with the student being referred for assessment by school staff. We will train 25 providers in Attachment Based Family Therapy (ABFT), certify 75 Question-Persuade-Refer (QPR) trainers, and provide QPR training to staff in at least 75 school districts. We will also provide Mental Health First Aid training to staff in at least 20 school districts. As part of our community engagement component, we will conduct town hall meetings in at least 5 of the affected counties and expand the state's Youth Leaders in Kansas (YLINK) program to 12 additional groups in these catchment areas. We will build on this infrastructure through future state and federal funding opportunities.

Kansas COVID-19 Response proposes to meet the needs of people with SMI, SMI/SUD co-occurring issues, and people with less severe mental health issues including healthcare practitioners resulting from the current COVID-19 crisis through the creation of crisis response infrastructure which includes expansion of telehealth, expanded crisis response services, and enhanced recovery support services. We anticipate serving a total of 10,365 individuals during the grant period.

The purpose of this project is to prepare physicians to address substance use disorders, especially in rural and underserved populations. The project's three goals target the education of medical students, the training of family medicine residents at three residency programs, and the enhancement of faculty and community physician resources. Specific objectives include education in substance abuse for medical students in each year of the curriculum; screening, brief intervention, and referral to treatment certification, medically assisted treatment training, and comprehensive didactic and clinical education in substance abuse and related disorders for family medicine residents; and didactics and practical training for faculty and community physicians. This project will serve more than 500 medical students, residents, and practicing physicians per year, and potentially twice than many over the life of the project. The project will quickly improve access to high-quality care, focused on patients with substance abuse disorders and their families, for the vulnerable populations served by physicians in the State of Kansas. The substantial long-term impact is the provision of access to substance abuse care for populations served by graduates. As these medical students and residency graduates have some of the highest national rates of practicing in rural and underserved areas, the project should make substantial contributions to SAMHSA clinical priorities. This impact will be increased by dissemination of outcomes and model projects to other educators. The project team will be responsible for conduct of activities and achievement of outcomes. This team will monitor and adjust activities using a Rapid Cycle Quality Improvement process and will be responsible for all required reporting to SAMHSA. The project is designed to increase education and training opportunities for medical students, family medicine residents, and practicing physicians. This is a proposed project of the Department of Family and Community Medicine of the University of Kansas School of Medicine-Wichita. The project will use the resources of the hosting institution, partnering community organizations, and State and Federal agencies; and education and clinical activities will be led by a family physician with fellowship training in addiction medicine.

Overview: Leveraging long-standing relationships from the Telehealth ROCKS school-based telebehavioral health network, the Kansas Disaster Outreach in Schools (KanDO) project will meet pressing community needs related to flooding, tornados, and droughts, among other natural disasters. In the trusted school environment, the KanDO project will provide evidence-based direct telebehavioral services to at least 650 students, training to 650 health, social services, and educations professionals (clinicians and teachers), and engage at least ten percent of the targeted area population, or 13,000 individuals. The KanDO project will extend quality improvement, training, and telementoring opportunities to school teams and communities to advance post-disaster best behavioral practices. Goals: Goal 1 (ENGAGEMENT): To engage diverse community stakeholders to tailor, implement, and evaluate strategies and interventions to enhance student behavioral health following natural disaster. Goal 2: (SERVICES): Using evidence-based behavioral interventions for K-12 students, increase access to the strategies and interventions across the three-tier behavioral needs (universal, targeted, and individual). Goal 3 (TRAINING/MENTORING): Utilizing a range of onsite and distance education delivery approaches including Project ECHO, increase quality improvement, continuing education, and telementoring opportunities related to post-disaster behavioral support. Goal 4 (WORKFORCE): To support trainee participation in KanDO activities across the workforce pipeline, at the KanDO schools, their communities, and the academic health center. Populations Served: The target student population is the Telehealth ROCKS school-based telebehavioral health network. This includes15 school districts served by South Central Special Education Cooperative; the Coffeyville School District; and schools served through Community Health Center of Southeast Kansas. This network will directly serve 19 sites in 10 counties impacted with a total population of 134,772. The counties have all been declared disaster areas in 2019 due to flooding and all qualify as primary care, mental health, and dental Health Professional Shortage Areas (HPSAs), as well as MUAs. The KanDO project will extend culturally sensitive behavioral services across K-12 students, including those who may have unique disaster recovery behavioral needs. This includes extending services to at-risk populations and their families, including youth with behavioral health and/or substance use concerns; children with intellectual and/or developmental disability; children with special healthcare needs; and children with mobility limitations. Strategies & Interventions: Evidence-based strategies will mirror the three-level pyramid of universal, targeted, and individual interventions (Adapted from Pynoos et al., 1998) using evidence-based approaches. The first-tier interventions will extend Psychological First Aid and Child-Adult Relationship Enhancement, as well as resilience training for students and faculty. The second-tier interventions will utilize the Skills for Psychological Recovery (SPR) and Modular Approaches to address trauma and grief. The third-tier strategies will include strategies for young elementary students, Parent Child Interaction Therapy, and for later elementary and pre-teens an adolescents, Trauma-Focused Cognitive Behavioral Therapy.

TIGER COMMUNITY’S PATHWAY TO HELP, HOPE AND SUCCESS Fort Hays State University’s (FHSU) TIGER COMMUNITY’S PATHWAY TO HELP, HOPE AND SUCCESS will ensure our students, faculty, and staff have adequate information, resources, and access to services which allow them to maintain overall wellness in their lives. This will positively impact our students’ mental health, and therefore increase our students’ retention, persistence, and success during their university career and beyond. With 15,100 total students served by approximately 1,000 faculty and staff, the FHSU community is extremely diverse, especially in comparison to our peer institutions. This project targets all FHSU students, faculty and staff. The most recent available demographic data indicates that 60.4% of FHSU students are female and 39.5% are male with the average age being 27.1. 51% of the undergraduate student residence is in-state, and 48% is out-of-state. The percent of American Indian students is less than 1% with other categories as follows: Asian 26%, Black or African American 4%, Hispanic/Latino 7%, White 59%, two or more races 2%, and racial/ethnicity unknown 1%. FHSU has seen a 77.7% increase in its Hispanic student enrollment over the past five years. There are currently 134 Chinese students on the FHSU campus. According to Collegeportraits.org, 28% of FHSU undergraduates are low-income with 378 students receiving veteran benefits. Goals: 1. Increase coordination of services on campus and the collaboration between FHSU and its community partners to enhance identification, treatment and management of students experiencing mental health distress or crisis. 2. Increase the FHSU campus community's ability to recognize, manage and prevent suicide and create a campus environment that promotes good mental health and substance abuse practices. 3. Expand FHSU's current suicide prevention activities to reach a larger number of students. 4. Increase the commitment to the emotional well-being of FHSU students. Brief Objectives: FHSU will begin building a campus and community network through the signing of memorandums of understandings with campus and community resources. We will hire a case manager to assist with student needs. FHSU will implement online as well as face to face gatekeeper suicide prevention and substance abuse trainings for university and community constituents. Kelly Center (Counseling Center) data indicates the top 5 reasons students seek services are: depression; anxiety; relationships; stress; and substance abuse. The Kelly Center currently reaches approximately 3000 students a year. Implementation of grant objectives will allow us to increase this number to 4,000-5,000 using online and face to face training outreach.

Four County Mental Health Center, Inc. proposes to strengthen and expand current behavioral health services and collaborate with physical healthcare providers to create a comprehensive and integrated healthcare model across Chautauqua, Cowley, Elk, Montgomery, and Wilson Counties in Southeast and South Central Kansas. This highly rural area is home to an estimated population base of 81,820. The region has an estimated 17.2% of persons living in poverty and an average median annual household income of $43,330. There are widespread risk factors for the area including intergenerational behavioral health conditions, social norms favorable to substance use, early onset drinking and use of substances, high rates of depression, and death by suicide rates that are 3% higher than the national average. The area is considered a Health Professional Shortage Area and citizens of the region must seek care outside the geographical boundaries for many critical services and supports. The project will serve an estimated 6,575 unduplicated individuals in Year 1 and 6,970 individuals in Year 2. The CCBHC will serve everyone, regardless of their ability to pay or their county of residence. The primary target population for services will be individuals with mental health conditions, substance abuse disorders, or co-occurring disorders who lack health insurance coverage, are underinsured, or health insurance has been formally deemed unaffordable. There will also be concerted care coordination efforts placed on the Service Member, Veteran, and their Families (SMVF) priority population. The goals of the project are 1) to increase population penetration for integrated healthcare services through the CCBHC model of care which involves service expansion and collaborative efforts with area healthcare providers, and 2) increase human resource capacities to promote the attraction and retention of qualified personnel through increased wages and strategic recruiting efforts. Year 1 Objectives for Goal 1 include: increasing the number of patients served; providing care coordination services to at least 100 SMVF; having at least 50% of CCBHC patients with a Primary Care Provider listed in their electronic health record; providing Assertive Community Treatment to at least 50 individuals; tracking and quarterly reporting on key health indicators of at least 75% of enrolled patients; hiring of additional treatment staff to serve unmet needs; and creating more culturally-sensitive practices for the SMVF population through PsychArmor training. Year 1 Objectives for Goal 2 include: increasing social media recruiting efforts by 30%; fostering relationships with schools and key statewide job placement organizations to increase recruiting opportunities by 30%; broadening opportunities for referral bonuses and increase the bonus amounts by at least 30%; create more competitive salary and benefit packages to reduce the number of open positions by 30%; and reducing employee turnover attributed to low salaries by 30%.

With a 70% increase in the rate of suicide deaths from 1999-2018, Kansas is in dire need of systematic transformation to address this serious public health problem. Implementation of Zero Suicide in Health Systems in Kansas will focus on those 25 years of age and older who are at increased risk of suicide due to previous attempts, history of severe and persistent mental illness or multiple diagnoses, and those with military affiliation. Commitment to the Zero Suicide model provides the foundation for safer suicide policies, protocols, and processes by being leadership driven, partner and resource focused, and building capacity and knowledge around suicide assessment, intervention, and treatment across the behavioral health continuum of care. Community Mental Health Centers (CMHCs) are integral to the total mental health system in Kansas, thus a critical partner in preventing suicides and the initial focus for implementation of the Zero Suicide in Health Systems. They have a strong commitment to supporting those they serve in the least restrictive environment and provide services to all those needing it, regardless of economic level, age, or type of illness. CMHCs are familiar with other health systems and key stakeholders in their respective service areas and are poised to lead community-wide implementation of Zero Suicide. CMHCs serve more than 140,000 Kansans annually. The goals for Implementation of Zero Suicide in Health Systems in Kansas are to increase screenings and assessment to identify those at increased risk for suicide; provide trainings to support a prepared, competent, and confident workforce in identification, assessment, and treatment to those at risk for suicide; provide mechanisms for the continued support and encouragement to those at risk for suicide; and bolster efforts to include those with lived experience in suicide prevention. This will be accomplished through engagement with the Zero Suicide Institute through Workshops, Academies, and Consultation to learn about and implement the seven essential elements of suicide care. Trainings on screening and assessment will be provided and enhancements to electronic health records will be facilitated to encourage screening of all individuals and continued care for those at risk. Additionally, gatekeeper trainings will highlight the role of everyone in suicide prevention and mental health professionals will be educated on CAMS, a therapeutic framework. Mental health professionals and other key partners will also be instructed on suicide management plans and access to lethal means. Continued support of those at risk for suicide is warranted and will be managed through CMHCs with augmentation by the Kansas Suicide Prevention Lifeline. The success of the project will be measured in multiple ways including suicide death rate; suicide attempts, ideation, and self-harm emergency department visits and hospital discharge rates; BRFSS questionnaire; number of screenings conducted; number of patients served at risk for suicide; number of follow-up contacts to encourage continuity of care; and survey of the mental health workforce’s confidence in providing service to those at risk of suicide.

The Kiikaapoaa (Kickapoo) Tribe in Kansas is a federally recognized sovereign Indian Tribe that consists of more than 1,600 enrolled members with approximately half residing on the Kickapoo Nation Reservation in rural Brown County, Kansas. The Mission of the Kickapoo Tribe in Kansas is to enhance the quality of life for the tribe, its members, and its community while preserving its culture and retaining its right to self-governance by protecting tribal sovereignty and assets. It is because of this strong commitment to improving life for the tribe that the KTIK is dedicated to addressing intergenerational mental health, substance abuse, and trauma. By expanding the efforts of the Kickapoo Tribe in Kansas Native Connections program, we will: 1) Strengthen a system of behavioral health and wellness care for Kickapoo youth and young adults; 2) Improve availability and accessibility of behavioral health and wellness programs for youth and young adults in the Kickapoo community; and 3) Engage community leaders and members, including youth and young adults, in building strong connections to promote Kickapoo culture and tradition. We aim for our youth, as critical members of our intergenerational community circle, to have a safe and caring space to make friends, learn new skills, connect with our culture and language, and develop healthy, happy, thriving futures. Our Native Connections program will increase opportunities for growth and access to community leadership for its youth by engaging in community-based outreach that fosters stronger family relationships, building safe and substance-free spaces for youth to come together, and by educating youth on healthy and traditional practices for increased mental wellbeing. Together our community and partners will realize a holistic vision of healthy, happy, thriving adolescents, for they are the future leaders of our Tribe.

The Prairie Band Potawatomi Nation (PBPN) is a federally recognized sovereign Indian Tribe in Northeast Kansas, with more than 5,000 enrolled members. The vision of the PBPN as a sovereign tribe is to (1) ensure self-sufficiency that respects diversity and equality while working within a spirit of cooperation and fairness for a high standard of living and quality of life, (2) strive to provide and environment of improved well-being for our people including education, health, safety, and welfare while valuing our culture, traditions, and all resources, and (3) accomplish these things for all generations with a system of value-based management to respect all views. Together, we can build a healthy, safe community that celebrates our culture, traditions, and values. As we work to address the hard issues our community faces, we honor our tribe's future and continuation of culture, making youth mental health, substance misuse, and overall well-being in the community major concerns to our leadership and members. We know that tribal communities - and particularly Native youth - experience a higher risk of substance misuse and depression due to the damaging legacy of historical trauma and its continuing impacts on Native families. Thus, the Prairie Band Potawatomi Nation proposes the Prairie Band Potawatomi Nation Native Connections Project, a social services-based initiative that will implement evidence-based and culturally responsive approaches to build resiliency, promote positive youth development, and to mitigate risk factors for suicide and substance misuse. The project's goals are to: (1) foster the creation of a collaborative, comprehensive system for youth and young adult mental wellness in the Prairie Band Potawatomi Nation community; (2) raise youth's awareness on mental health, reduce stigma associated with mental illness, promote help seeking behaviors and culturally appropriate emotional well-being practices and prevent suicide/substance misuse through individual education and outreach events; and (3) create a continuum of care that employs a resilience, strengths-based framework that responds to multifaceted trauma faced by youth. Our youth are our future; they are tomorrow's elders and leaders. It is critical that we build a strong system of support around them to ensure the overall health and longevity of our people.

This grant will provide access to medication-assisted treatment, to reduce unmet treatment needs, and to reduce overdose deaths for Kansans suffering with opioid/stimulant use disorders. Strategies and interventions will focus on evidence-based prevention, treatment and recovery support services. The focus will be on illicit use of prescription opioids, heroin, fentanyl and fentanyl analogs, as well as stimulants.