MD Discretionary Funding Fiscal Year 2021

Maryland's Alliance for Suicide Prevention, Intervention, Recovery, and Education (MD-ASPIRE) establishes a network for rapid response to crisis and transition to care, particularly for victims of domestic violence, individuals experiencing unemployment, and adults ages 25 and older who have recently been seen in the emergency department (ED) or impatient psychiatric facility for suicidal ideation or attempt. By assessing suicide risk and connecting at-risk adults to essential services, MD-ASPIRE aims to reduce the incidence of suicide and suicide-related behaviors with a focus on groups heavily impacted by the COVID-19 response. Led by the state Behavioral Health Administration and in partnership with 211 Maryland, United Way of Central Maryland, the Life Crisis Center, the American Association of Suicidology, the Maryland Chapter of the National Alliance on Mental Illness, and the Maryland Department of Labor, MD-ASPIRE will serve 1,000 adults ages 25 and older throughout the state (51.5% White, 30.7% Black, 10.4% Hispanic, and 7.0% Asian). Over the past two years, Maryland's suicide rate has increased. Many of the impacts of COVID-19 - including an unprecedented increase in sudden unemployment, restrictions forcing many victims of domestic violence to shelter in place with abusers, facing a changing behavioral health system as a recent discharge from an EDs and/or inpatient psychiatric facility - amplify existing suicide risk. The goals of MD-ASPIRE are: 1) Establish a caring transitions programs that will rapidly follow up with adults who have been discharged recently from EDs and inpatient psychiatric facilities, assess suicide risk, and connect them to outpatient care, 2) Ensure patient safety by providing caring contacts, continued risk assessment, and connection to behavioral health resources for 9 months after discharge, 3) Provide suicide risk and response training for behavioral health clinicians, 4) Develop screening capacity in sectors that interact with individuals experiencing unemployment, 5) Provide community support services for individuals with mental illness or lived experience of suicide, 6) Expand telehealth and virtual options for case management, training, and support groups , and 7) Connect victims of domestic violence with specialized risk assessment and expanded resources.

This application entitled, Building on Success to Address Mental and Substance Use Disorders During COVID-19, seeks to expand upon existing crisis services across the entire state to meet the expanding needs of children and adolescents including their families as well as health care workers/first responders and their families. The focus is on those experiencing a behavioral health escalation, including both those with and without prior behavioral health symptoms, who have been impacted by COVID-19 (directly or indirectly) and put at risk for adverse outcomes. Our plan includes building upon the existing children, adolescent and young adult mental health infrastructure in the State of Maryland and the existing crisis services system to expand access to crisis services across the entire state. Using existing psychiatric consultative platforms, and telehealth resources, our goal is to both meet the acute needs resulting from the COVID-19 health crisis, while also developing a comprehensive crisis response system that includes a more robust mobile crisis response resource for children, adolescent and young adults utilizing a telehealth platform. This will be developed through a network of triage entry points and targeted interventions and referrals. In addition, because the trauma, stress, and loss associated with the COVID-19 crisis will inevitably result in exacerbation of pre-existing mental health and substance abuse problems, we seek to expand the availability of trauma-informed evidence-based treatments (EBTs) which can be delivered via both telehealth and traditional service models. An ongoing survey of the current gaps in crisis services and an independent capacity assessment/review of currently available care coordination services will provide valuable information for quickly targeting these populations and their needs. Screening and assessment mechanisms will be strengthened by consultative collaborations with additional health care resources including pediatricians and other primary care services, school personnel (including school based mental health services), and through online mechanisms as appropriate. Maryland’s continuum of child and adolescent mental health services is feeling the stress brought on by the COVID-19 crisis. For example, group homes are not accepting youth or require "testing" before admission. Foster children who have tested positive are stuck in hospitals. We plan to fill the gaps in the quantity and quality of needed care through a partnership with the Behavioral Health Integration in Pediatric Primary Care Program (BHIPP), a collaborative with the Departments of Psychiatry at Johns Hopkins Medical Institute (JHMI) and the University of Maryland (UMB). Additional local partner organizations will be brought in as needed. Over the 16-month period of this award it is estimated that between 5,000 children and their families will be screened and assessed statewide through triage crisis entry points, 750 will be referred and engage in Evidenced-Based and Supportive treatment and 500 healthcare workers/first responders will be served. We will assess the benefit by evaluating outcome measures at engagement and on regular intervals. This is a tremendous opportunity to improve on behavioral health crisis response service at this very critical time for families in our State.

The ACCESS Port Towns Family Health and Wellness Center Health Awareness Training (MHAT) program intends to provide mental health awareness training to individuals living in Prince George’s County Maryland, including but not limited to parents, teachers, emergency first responders, law enforcement, veterans, armed services members, and their families in order that they can recognize the signs and symptoms of mental disorders and be able to employ crisis de-escalation techniques. In addition, these individuals will be educated about the resources that are available in the community for individuals with a mental disorder. Trainees will also be trained on how to refer persons in need of mental health services and/or experiencing a crisis to appropriate services. The program will use the evidenced-based Adult and Youth Mental Health First Aid (MHFA) training program in addition to the extra training MHFA modules for public safety, military/veterans, and fire/EMS.

Arundel Lodge, a Community Mental Health Center operating in Annapolis, Maryland, submits this proposal, hereafter known as the COVID-19 Recovery Project, in partnership with the Maryland Behavioral Health Solutions (MBHS) and its provider network. The project will build capacity and deliver evidence-based behavioral health services to adults and children with mental health and co-occurring addiction treatment needs across the state of Maryland with special attention to uninsured and underinsured individuals, underserved minority populations, and veterans. COVID-19 Recovery Project will serve 800 unduplicated individuals annually with a total of 1,600 lives across the lifespan of the project. Arundel Lodge and its partners will engage the target population in the availability of treatment for serious emotional disturbances (SED), serious mental illnesses (SMI), and co-occurring disorders (COD). COVID-19 Recovery Project goals include: Goal #1: Restore needed outpatient services for the target population that addresses unmet need resulting from the pandemic. Objective #1: Re-establish full complement of outpatient services support for both community and residential populations, establishing target population goals, outcome metrics, and reporting requirement at Arundel Lodge and with ten members of the MBHS provider network. Objective #2: Provide/update trauma-informed training with clinical teams across the MBHS provider network, standardizing outcomes tools and tracking to support continuous quality improvement processes. Goal #2: Increase capacity of CMHC staff to address crisis and emergency response, improve time to access care, and improve patient outcomes by facilitating access to timely hospital discharge information via the state’s health information exchange and standardizing staff use of episode tables/provider workflows. Objective #1: Integrate the Chesapeake Regional Information System for Patients (CRISP) health information exchange (HIE) data – hospital admission/discharge – into the MBHS data warehouse and EMRs of participating MBHS agencies. Outcome #2: Implement utilization of Greenspace Health, a patient assessment and outcomes tracking system standardized across the MBHS participating provider agencies, to improve and track client outcomes. Goal #3: Improve and support the mental health of Arundel Lodge and MBHS provider network staff, focusing on organizational health, culture, and wellness programs and resources to complement existing Employee Assistance Programs (EAPs) and Human Resource (HR) programs. Objective #1: Utilize technical assistance, training, and effective educational strategies to improve behavioral health workforce engagement. Objective #2: Collaborate across the COVID-19 Recovery Project to evaluate current EAP resources and implement evidence-based organizational health strategies. Objective #3: Establish an Employee Emergency Fund that complements current H.R. efforts to support staff experiencing unforeseen crises resulting from COVID-19 related challenges.

Arundel Lodge CCBHC Expansion and Behavioral Health Urgent Care Clinic Project propose to add an Urgent Care Behavioral Health Clinic (UCCBH) to its Comprehensive Continuum of Services for the treatment of persons with Mental Health and Substance Use Disorders. UCCBH will be staffed by 3 Nurse Practitioners operating 12 hours per day (9:30am to 9:30pm) and 7 days per week that will assess and initiate treatment on a walk-in or virtual basis for 2700 persons in its first 2 years. In addition, Arundel Lodge will develop with one of its IT vendors a data warehouse that will passively mine our EMR and General Ledger for actionable data regarding clinical outputs, outcomes and costs. This will strengthen our participation in systems with value-based compensation. Arundel Lodge seeks to expand to a Certified Community Behavioral Health Center by developing a comprehensive Behavioral Health Urgent Care Center operating 12 hour per day and 7 days per week. Mental health issues are rising very rapidly. In a needs assessment completed in 2018 it was determined there has been a 70 percent increase in residents seeking public mental health services since 2012; 16,343 Medicaid and uninsured residents were served by the behavioral healthcare providers in 2018. The two highest percentage increases in residents served are the early childhood population and those over 65. Services identified by the needs assessment for persons with mental health and substance use disorders include: Further support for the Mental Health Agency’s very successful Crisis Intervention system and rapid engagement in outpatient treatment with Urgent Care Clinics. The UCBHC will fill an important gap in the Crisis System of Anne Arundel County. Currently, the crisis system does not initiate treatment and needs to refer to outpatient mental health and substance use providers. Arundel Lodge has been the most responsive provider through its same day access for diagnostic evaluation. The Urgent Care Clinic will be able to go beyond this step and immediately initiate treatment during the crisis. During the screening, assessment, and diagnosis a RN will identify emergency medical issues that need to managed by Luminus/AAMC ED and identify follow-up referrals for primary and specialty care. A licensed behavioral health professional will conduct a thorough and integrated evaluation for mental health and substance use disorders that includes a risk assessment. A Nurse Practitioner will also be available to conduct a medication evaluation for those persons who would benefit from MAT or psychopharmacology.

Board of Child Care (BCC) will implement the Youth Mental Health First Aid Project, training youth care professionals, educators and school staff, health and human services workers, mental health outreach and crisis personnel, as well as parents, family, and community members, in the evidenced- based Youth Mental Health First Aid (YMHFA) model. Training participants are adults who work with, support, and/or interact with school-age youth and youth that have co-occurring mental health and substance use disorders, serious emotional disorders (SED) and/or significant histories of complex trauma. Throughout the lifetime of the project, 2025 individuals who work with and care for these at risk youth will be trained in YMHFA. The success of this initiative will be delivered through a strong network of community partners committed to supporting the increase of capacity for YMHFA training in the target regions of Baltimore, Anne Arundel, and Mid Shore (Caroline, Talbot & Dorchester) counties of Maryland (MD); Berkeley and surrounding counties in West Virginia (WV); and Cumberland and surrounding counties in Pennsylvania (PA). YMHFA addresses identified service gaps in each region by providing training on universal, early, and secondary levels of awareness and intervention for mental health and substance use disorder needs. YMHFA responders will develop the confidence needed to flexibly respond to youth in need, meet them where they are, and refer them to clinical services and other supports, including self-help resources and resilience-building strategies. Mental Health First Aid is an internationally recognized program that is listed in SAMHSA’s National Registry of Evidence-based Programs and Practices (NREPP). The 8-hour YMHFA course is designed for adults who regularly interact with adolescents. As a public education program, Youth Mental Health First Aid has the potential to reduce stigma, improve mental health literacy, and empower individuals. The course teaches participants the risk factors and warning signs of a variety of mental health challenges common among adolescents, including anxiety, depression, psychosis, eating disorders, and substance use disorder. Participants do not learn to diagnose, nor how to provide any therapy. Rather, participants learn to support youth developing signs and symptoms of a mental illness or in an emotional crisis by applying a core five-step action plan. The YMHFA training also addresses the role of trauma as a risk factor for mental illness, a common issue for the target youth population of this project. BCC’s partners for this project include the Anne Arundel Co. Mental Health Agency, Baltimore Co. Bureau of Behavioral Health, Baltimore Co. CASA, Caroline Human Services Council, Family Resource Network of the Panhandle, Blue Ridge Community & Technical College, Shepherd University, Berkeley County Schools, WV Dept of Health & Human Services, Team Care LLC., United Methodist Association and the Balt – Wash, Pen – Del and Susquehanna Conference of the United Methodist Church.