MD Discretionary Funding Fiscal Year 2020

A coalition led by the National Federation of Families for Children's Mental Health in partnership with the Council on Addiction, C4 Innovations, SAFE Project, and Boston University is launching SAMHSA's first National Family Support Technical Assistance Center (NFSTAC). NFSTAC is committed to providing training and technical assistance using a lifespan approach that focuses on serious emotional disturbances, serious mental illness and substance use disorders. This approach is anchored by the underlying principles that families play a vital role in supporting their loved ones and are the experts regarding their family support needs. Our approach advances partnership between clinical service providers and family members of individuals experiencing SED/SMI/SUDs to promote stronger and more sustainable intervention outcomes. To meet this goal, we will create connections between families, providers/clinicians, and other community members. We are committed to a lifespan behavioral health approach that focuses equally on SED/SMI and SUD issues and that is culturally grounded in the unique characteristics of varying genres of families (e.g., military, inner-city, remote-rural, tribal). Goals include: (1) Promoting education for clinicians, providers, and others regarding the importance of including family support; (2) Increasing access to comprehensive, multi-modal resources for family members and the general public to increase knowledge of SED/SMI and SUD; (3) Multi-modal training for healthcare professionals, educators, and other providers regarding family support/engagement strategies; (4) Increasing family member and provider understanding of HIPAA and 42CFR regulations pertaining to crisis situations; (5) Creating lifespan resources for families to facilitate access to support and treatment options for their loved ones; and (6) Increasing policymaker knowledge of evidence-based and promising practices such as family peer support. Objectives include, but are not limited to: (1) Provision of both virtual and in-person training for a diverse audience; (2) Development of toolkits to assist families seeking supports and services; and (3) Creation of a virtual library of resources for families, healthcare professionals and community providers. Our team is comprised primarily of family members who have loves ones of all ages with SED/SMI/SUDs as well as individual themselves in recovery. This lived experience, combined with our collective decades of experience as researchers, practitioners, TTA providers, and leaders in family engagement, involvement, and support in SED/SMI/SUD prevention, early intervention, treatment, and recovery, will inform every aspect of the NFSTAC, which will be anchored by a family-run organization. The effect of entrusting a family-run organization, in collaboration with local, state and national family-run partners, and a strong alignment with professionals who advance the importance of family engagement in their work, to implement the NFSTAC will be transformation in the delivery of TTA. It will also make clear to all stakeholders that lived experience and authentic family voice are the cornerstones of our NFSTAC approach.

The University of Maryland, Baltimore (UMB) will operate SAMHSA’s Center for Excellence on Behavioral Health Disparities Impacting the LGBTQ Community (CoE BHD LGBTQ) in partnership with Affirmative Research (AR) and Judge Baker Children’s Center, Harvard Medical School (JBCC). In collaboration with SAMHSA, the CoE BHD LGBTQ will provide training and technical assistance (TTA) to effectively implement change strategies within mental health (MH) and substance use (SU) disorder treatment systems to address disparities. The target audience for TTA is health care practitioners in clinical care settings as well as the broader public. Disparities research shows that LGBTQ people are at greater risk for MH diagnoses with increased likelihood to attempt and complete suicide, experience depression and anxiety, engage in substance misuse, and experience hospitalization for emotional reasons. Behavioral health (BH) disparities for the LGBTQ community have been connected to pervasive misperceptions held by the MH and SU workforce as well as a lack of culturally responsive BEBPs. Efforts to decrease and eliminate BH disparities for the LGBTQ population need to be grounded in an affirmative practice framework, strong implementation science, responsive TTA, development and implementations of culturally responsive BEBPs, and safe identification of sexual orientation and gender identity in data collection efforts. The CoE BHD LGBTQ will address these needs through a nimble and responsive TTA approach, grounded in implementation science and research on effective TTA provision, and designed to meet the interests, needs, and preparedness of practitioners. The CoE BHD LGBTQ will be structured to include subject matter experts (SMEs) from UMB, AR, JBCC, and an Expert Consultant Pool comprised of other researchers and implementers of best and evidence-based practices (BEBPs) in LGBTQ culturally responsive care at leading universities nationally, provider organizations, youth, young adults and their families, and adults with lived experience. Universal TTA will ensue broad-based dissemination aimed to increase awareness of BH disparities, Minority Stress, and effective strategies and BEBPs to address the MH and SU needs of the LGBTQ community. The CoE will disseminate resources through a monthly e-newsletter and maintain a website and searchable resource portal. Developed resources will include animated and video shorts, fact sheets, briefs, webinars, and online learning modules, as well as an annual environmental scan of latest research and BEBPs to support BH of LGBTQ people. Tailored TTA will include individualized supports through emailed rapid response, office hours, and virtual TTA. Intensive TTA will be individualized, in-depth TTA with training in BEBPs, expert consultation, and peer learning through Quality Learning Collaboratives utilizing the AFFIRM practice models. Across all partners and SMEs, the CoE BHD LGBTQ will have an extensive listserv reach and is projected to provide TTA to 3,000-6,000 practitioners per year for a total of up to 25,000-30,000 over 5 years. The CoE BHD LGBTQ will collaborate with other SAMHSA TTA providers.

The Maryland State Department of Education (MSDE) is submitting this Maryland AWARE II proposal to provide targeted, evidence-based practices to three Maryland underserved, high need, local public school systems, Baltimore City (BCPSS), Caroline (CCPS), and Talbot (TCPS) to scale-up the capacity to use a multi-tiered framework to improve student behavioral health outcomes and student and family linkages to mental health services. This project will provide Tier 1 training over the five years to a total of 7,500 school and community staff and families (serving 82,800 students annually) and will provide evidence-based Tier 2/3 training to 230 school and community providers (serving 6,650 students over 5 years). BCPSS is a diverse urban school district of approximately 73,000 students with elevated rates of poverty, depression, trauma, and exposure to community violence. CCPS and TCPS are rural school districts with approximately 5,800 and 4,700 students respectively. The two rural districts include diverse student populations, with high rates of depression and suicidal ideation, with limited access to mental health providers. Goals and objectives include: Goal 1: School staff, families, and community partners will receive training in evidence-based culturally competent and developmentally appropriate practices designed to increase the capacity to refer and connect students and their families with community-based behavioral health providers. Annual instructor trainings will be held for Youth Mental Health First Aid, Adverse Childhood Experiences Interface and Question, Persuade and Response. A systemic technical assistance strategy for instructors trained will emphasize cultural competency and developmentally appropriate practices. Goal 2: Improve school-based resources to immediately respond to the needs of students exhibiting signs and symptoms that warrant clinical attention will be developed. A Family Navigator will be hired in each LSS to support access to services and resources for students and families. Telemental health will be provided to facilitate the delivery of immediate services to students in need. LSS providers will be trained to provide treatment to students using evidence-based, school-based trauma treatments (CBITS and Bounce Back). Also, 30 providers each year will be trained by the Central East MHTTC on motivational interviewing and Screening, Brief Intervention and Referral to treatment. Goal 3: Guidelines will be developed for providing coordinated referral services and follow-up for students and families using evidence-based school and community practices and services. Each year the LSS and their respective schools will complete the School Mental Health Quality Assessment and Trauma-Responsive Schools Implementation Assessment and develop a strategic quality improvement plan. Goal 4: MSDE will build upon current State infrastructure to advance school mental health and safety policies to identify additional sources to improve, fund, and evaluate statewide school mental health. Existing policies and funding will be evaluated and recommendations will be made to facilitate effective and equitable school mental health.

The proposed Center for Safe Supportive Schools (CS3) aims to address existing gaps in the widespread implementation of trauma-informed schools (TIS) through a partnership between the National Center for School Mental Health (NCSMH), the NCTSN Center for Trauma Care in Schools (CTCS; Massachusetts) and the Center for Childhood Resilience (CCR; Illinois). The CS3 will extend the regional reach of current NCTSN Category II Centers focused on schools to the Northeast, Mid-Atlantic and Midwest and leverage the national reach of the NCSMH to integrate NCTSN resources into existing multi-tiered, comprehensive K-12 SMH systems across the United States. The CS3 will pursue three goals: Goal 1: Build state and district capacity to deliver multi-tiered, trauma-informed policies and programming, including universal (Tier 1), targeted (Tier 2) and intensive (Tier 3), within K-12 comprehensive school mental health (SMH) systems nationwide; Goal 2: Support training and implementation of school-based trauma interventions that attend to social determinants and injustices and engage and support specific marginalized populations, including youth of color and newcomer (refugee and immigrant) youth; Goal 3: Integrate TIS into pre-service educator and mental health provider preparation. Related objectives include facilitating communities of practice and completion of assessment of SMH quality and trauma-responsiveness in 6 states and 30 districts, providing Trauma-Informed SMH (TI-SMH) training to 3,000 educators and 60 administrators and training in at least one evidence-based Tier 2/3 trauma treatment for 570 SMH clinicians. NCSMH will engage an additional 12 states and 60 districts in TI-SMH continuous quality improvement via online and virtual implementation support via the School Health Assessment and Performance Evaluation System. Goal 2 objectives include the refinement of existing and development of new training and resources, as needed, on equitable and culturally responsive TIS, including enhancements to NCTSN and other evidence-based trauma interventions; training of 24 school administrators, 1,200 educators and 48 SMH clinicians on the impact of social injustices and determinants of health that contribute to health disparities and how to address these disparities within a TIS frameworks, 300 SMH clinicians on evidence-based strategies to engage and support youth of color in evidence-based trauma interventions; training of 8 school administrators, 200 educators and 16 SMH clinicians on multi-tiered systems of support for newcomer students, including universal supports and STRONG (Supporting Transition Resilience of Newcomer Groups), a Tier 2/3 intervention to support newcomer students experiencing psychological distress; and, engagement of 1,000 district and school users in culturally responsive and equitable TI-SMH. Objectives related to Goal 3 include producing a 12-hour online National Trauma-Focused Intern Training (T-FIT) Program for Graduate Social Work and Counseling Interns and participation in T-FIT by a minimum of 10,000 mental health interns; and, refining TIS training and resources for pre-service educators and training a minimum of 150 pre-service educators in TIS.

The Baltimore-Network of Early Services Transformation (B-NEST) project is designed to enhance access to integrated trauma-informed pediatric primary care for young children, engage families in preventing traumatic stress and increase capacity of pediatric professionals and local child-serving systems to address early childhood mental health needs. Trauma and poverty are pervasive in Baltimore. Nearly one-third of Baltimore children experience two or more traumas or adverse life events by age 17 and up to 20% demonstrate social-emotional concerns requiring intervention by kindergarten. With one in three children in Baltimore living in poverty, the historical trauma, racism, and disparities experienced by Baltimore's children have an enormous impact on their mental health outcomes. The University of Maryland School of Medicine (UMSOM) will implement B-NEST with predominately African American children ages 0-5 years living in poverty in Baltimore City. B-NEST will increase ACE prevention and early trauma intervention by implementing an integrated primary care program, HealthySteps (HS) in the UMMC pediatric primary care clinic to deliver evidence-based screening (2,000 children total), pilot attachment assessment tools (500 children and caregivers) and deliver targeted intervention to 250 children. We will link identified families to two-generational, evidence-based trauma treatment and attachment-based parent education interventions such as Child Parent Psychotherapy, Attachment Vitamins, and Trauma Focused-Cognitive Behavioral Therapy to provide 500 treatment services each year. B-NEST will also increase family and professional early childhood mental health knowledge and trauma responsive skills through training and coaching. We will implement the NCTSN PICC Toolkit and outcome tools to 2,000 children in our HS site and provide training in Attachment Vitamins to 25 pediatric PCPs, mental health providers, allied health professionals and community health workers and will bi-annually deliver this intervention to families through our HS site, Community Engagement Centers and/or city partnerships to 100 parents and caregivers. Lastly, community based services and activities will be conducted by a trauma-trained community health worker (CHW) added to the HS site to increase community engagement and access to family education and public awareness through peer-led interventions and workshops. The CWH will provide community voice to support localized implementation efforts and train a cohort of local grandparents to deliver ACE training in community settings (reaching 100 community members). Taken together (4,975 children, parents/caregivers, providers, and community members impacted), B-NEST will significantly enhance the availability, quality, effectiveness, and coordination of trauma-informed IECMH services in Baltimore. Lessons learned from B-NEST would serve as a blueprint for subsequent statewide implementation and collaborations with SAMHSA and NCTSN partners.

Volunteers of America Chesapeake & Carolinas (VOACC) proposes the VOA Hope Center, an expansion of its Mental Health Center in Prince George’s County (PGC), Maryland. VOACC will coordinate care to provide PGC residents with behavioral health disorders with access to a rich continuum of care that starts with prevention and continues through early intervention, treatment, and recovery supports. It will leverage technology—telehealth, mobile, and web—to “meet people where they are.” VOACC aims to enhance its ability to respond to evolving health care structures and make data-driven decisions to improve health. The VOA Hope Center will provide a robust array of behavioral health/substance abuse services to adults and children in PGC with veteran families as a focus subpopulation. VOACC will target adults with severe mental illness, individuals with substance use disorders, children and adolescents with serious emotional disturbance, and individuals with co-occurring disorders. Evidence-based strategies and interventions include the Sanctuary Model, Motivational Interviewing, Reinforcement-Based Treatment, Peer Support, Youth Peer Support and Transitional Age Youth Support, Family Psychoeducational Interventions for Children and Adolescents, Trauma-Informed Care, Assertive Community Treatment, and Medication assisted treatment. VOACC aims to provide services to 500 unduplicated individuals annually (1000 total for project period). Project goals include: (1) Increase awareness and understanding of the impact mental health and substance abuse has on children, adults, families, veterans and communities in PGC; (2) Increase access to behavioral health and substance use treatment to veterans, immigrants, adults, and children in PGC, and (3) Improve health, behavioral, and substance abuse outcomes for veterans, children and adults in PGC based on a philosophy of evidence-based practices services. Objectives to support Goal 1 include creating a behavioral health community council, developing an anti-stigma campaign, presenting at local/national conference and community meetings, and conducting targeted outreach. Objectives to support Goal 2 include creating a “No Wrong Door” policy, providing outpatient behavioral health services, offering bilingual services and translations, and serving clients in need of 24-hour mobile crisis. Objectives to support Goal 3 include providing screening for HIV and viral hepatitis, adopting a tobacco/nicotine inhalation product-free facility/grounds policy, collaborating with RWHAP grantees for HIV care/treatment services, implementing evidence-based practices for behavioral health and substance abuse in order to expand recovery options within the community, developing a provider score card system, and administering 1000 surveys and analysis of behavioral health and substance use outcomes to assess well-being and positive consumers by the end of the project period.

The Coalition serves Southern Prince George's County, Maryland, a community of 85,506. The goals of the coalition are to establish and strengthen community collaboration in support of local efforts to prevent youth substance use. The coalition will achieve its goals by implementing these strategies to increase social media campaigns, prevention messaging, peer leadership, capacity building to reduce youth alcohol and marijuana use.

HIV/AIDS continues to be a major health concern, especially among ethnic minorities living in Prince George’s County. To address this issue in the county, Access to Wholistic and Productive Living Institute intends to implement the Prevention Navigator program. The program has two goals: (1) Decrease substance use in the community by implementing an evidenced-based program among youth ages 13-18 that addresses behaviors that may lead to the initiation of substance use.; and (2) Decrease HIV/AIDS in the community by implementing an evidenced-based program in the community that addresses high risk behaviors that may contribute to HIV/AIDS among racial/ethnic minorities ages 13-24. The program will use two evidenced-based practices, Popular Opinion Leader (POL) and Community Promise to address both HIV and substance misuse. A key component of the Prevention Navigator Program is the use of Peer Navigators who will help conduct the core activities of the program. Activities include but are not limited to partnering with various community sectors, implementing public messaging and awareness campaigns on the risk behaviors and appropriate cautions associated with the risk of HIV transmission and substance misuse, providing opportunities for screening and testing for HIV and viral hepatitis, providing navigation services to link individuals to care and substance abuse services, and providing education and training to healthcare providers on substance use disorder treatment.

The project is the Substance Abuse and HIV Integrated Prevention Prevention Navigation Project (SHIPS-Prevention Navigators). The population to be served is heterosexual Black, Non-Hispanic females at the highest risk for HIV and substance use disorders ages 20- 49 living in Prince George's County, Maryland. The strategies to be implemented include Community Health Workers (CHW) linking participants to care, creating public messages and awareness campaigns, social media campaigns for HIV and Viral Hepatitis (VH) screening and testing, HIV and VH screening and testing, and education and training for substance use disorders and HIV providers. Goal 1 Increase community-based strategies for HIV and SUD Obj 1 Establish a Community Advisory Board Obj 2 Conduct a Peer-2-Peer Public Messaging and Awareness Design Lab Obj 3 Conduct education and training for providers on screening for HIV, linking to clinical care, and PrEP Obj 4 Disseminate the prevention messages to 50% of participants in the PGCHD HAP Program and STI clinics Goal 2 Increase capacity of CHW to link participants to care Obj 1 Train 10 CHW to provide navigation services to participants Obj 2 CHW link to care 10% of participants Goal 3 Increase screening and testing for HIV and VH Obj 1 Create a social media campaign for screening and testing for HIV and VH for 10% population in Prince George's Community College and the PGC Department of Social Services and STI clinics Obj 2 Collaborate to hold bi-annual (twp per year) targeted HIV and VH testing

Cecil County Drug-Free Communities Coalition is a collaborative substance abuse prevention and reduction project focused on community and school-based initiatives.