ME Discretionary Funding Fiscal Year 2023

This project will establish a new 988 coordinating position embedded in Maine’s statewide crisis call center—the Maine Crisis Line (MCL). The MCL 988 Coordinator will actively partner with Maine’s Office of Behavioral Health to build the foundational collaborations and cross-sector connections being forged across the crisis system as Maine plans for 988 implementation. As an integral part of the state and local 988 Community of Practice, the 988 MCL Coordinator will play a pivotal role in the success of 988 by strengthening state and local efforts to effectively leverage 988 as a catalyst for Maine’s broader crisis system transformation. Additionally, as 988 is activated and marketed locally and nationally, the corresponding projected rise in call volume will necessitate increased staffing infrastructure in order to achieve SAMHSA’s national standard of a 90% in-state call answer rate. The MCL 988 Coordinator will be fully trained to serve as auxiliary crisis call answering staff, enhancing MCL’s ability to maintain effective operations in the case of an unexpected surge in demand or a workforce shortage. This enhanced staffing capacity and resilience will serve to ensure effective and appropriate care for those in crisis, and to enhance and accelerate coordination of Maine’s 988 crisis system. Goals and objectives: Goal 1 - Enhance and strengthen coordination between state and local entities for the implementation of 988 crisis response system to ensure successful launch and ongoing development of 988 crisis call center in the context of broader crisis system development. Objective 1 - A robust system of collaboration, planning and reporting between DHHS-OBH, Maine’s crisis call center, and crisis system stakeholders. Objective 2 - A dynamic, issue-focused 988 Crisis Response Community of Practice (988 COP), holding monthly meetings to strategize efficient and effective cross-sector crisis response. Goal 2 - Increase integration and interoperability of crisis call center with key elements of the crisis response system to ensure seamless and appropriate crisis response. Objective 1 - Define 3-5 priority issues to solve, starting with 911/988 interoperability. Objective 2 - Develop proposals, implementation plans and trainings for operational and policy changes required to solve the identified priority issues, starting with 911/988 interoperability. Goal 3 - Expand 988 crisis call center capacity to meet national operational standards. Objective 1 - Increase staffing capacity. Objective 2 - Achieve target answer rate of 90% Objective 3 - Develop chat/text and follow-up plans. Objective 4 - Support adoption of real-time service locator tool.

Maine Department of Health and Human Services (DHHS) aims to improve Maine’s behavioral health system to expand access to behavioral health services, meet individual and community needs, improve quality of care, and deliver interdisciplinary, integrated behavioral healthcare to any person regardless of diagnosis or ability to pay. To achieve this aim, Maine DHHS will work collaboratively with behavioral health providers, people with lived experience with behavioral health conditions, and state and community partners to design Maine’s Certified Community Behavioral Health Clinic (CCBHC) model. The developed model will be responsive to current and future recipients of care, will strengthen Maine’s behavioral health workforce to meet community needs, and will have an innovative system for payment and quality measurement. This Planning Grant will allow Maine DHHS to fully prepare for the Demonstration Grant opportunity, with the intention of expanding capacity, accessibility of behavioral health outpatient services and rehabilitation, recovery, and peer supports for individuals living with Serious and Persistent Mental Illness (SPMI) and Substance Use Disorders (SUD) and for children living with Social Emotional Disturbance (SED). The priority populations for Maine to identify supportive and connected care within the CCBHC model include service members and veterans, children and adults with SPMI/SED or SUD and co-occurring Intellectual and Developmental Disabilities (IDD), and justice-involved youth and adults; Maine seeks to identify the most appropriate evidence-based practices (EBP) to best meet the behavioral health needs of these populations. The selection of CCBHC services, activities, and EBPs will be informed by a statewide Community Needs Assessment. The selected services and activities will direct the development of a Maine CCBHC cost report, prospective payment system (PPS) methodology, and a CCBHC certification process. Maine DHHS will use its experience and knowledge of value-based and alternative payment models to develop a monthly PPS-2 rate methodology and quality measurement to incentivize high-quality care. In preparation for the Demonstration Grant, Maine will use an application process to identify behavioral health organizations with the greatest readiness to meet the certification requirements. Through the implementation of CCBHCs, Maine intends to develop a statewide CCBHC model and Medicaid PPS that will transform behavioral healthcare delivery in the communities they serve.

Maine Health, doing business as Maine Behavioral Healthcare, proposes to establish Project REMH (Rural Education on Mental Health) aimed at preparing and training school staff to appropriately and safely respond to students with mental health challenges. The geographical catchment area of Project REMH is Washington County, a rural county in Maine with high rates of child trauma and Adverse Childhood Experiences. In addition, the project includes the Passamaquoddy tribal reservation at Pleasant Point. Project REMH’s target population(s) are as follows: 1) children and youth (grades K-8) who may be predisposed to, or experiencing mental illness; 2) school staff (grades K-8); and 3) staff of community-based mental health agencies with the potential to support schools (including staff and students) within Washington County and the Pleasant Point Reservation. Currently there is a paucity of training and resources for school staff in communities with significant mental health needs. To address this deficit, Project REMH employs a multi-tiered training framework as follows: Tier 1: provide universal training in Youth Mental Health First Aid to all partnering schools; Tier 2: provide small group instruction on de-escalation strategies to select school staff and leadership; Tier 3: provide targeted coaching and consultation to individual teachers with students at risk of developing serious mental illness. In addition, Project REMH will produce a resource and training guide for all training participants and partner with local mental health agencies to ensure effective referrals of students with mental health needs. An evaluation of the project will be conducted to monitor quality and outcomes. It is anticipated Project REMH will serve an average of 229 unduplicated individuals each year, for a total of 1,146 throughout the project period.

Spurwink ShifaME Trauma Systems Therapy for Refugees uses Trauma Systems Therapy adapted for refugees (TST-R), an evidence-based practice, to provide culturally appropriate mental health services to refugee children, adolescents, and their families in six communities in Southern Maine who have or at risk for mental health issues due to trauma. TST-R addresses a child's trauma system from a social ecological perspective, working within the unique ecology of each child and family, and building systems of prevention and community resilience building, targeted skill-building, and stress reduction interventions for at-risk youth, and intensive therapeutic intervention for refugee youth with significant psychological distress. The ShifaME model includes community engagement, school-based groups, and home-based family treatment interventions. All tiers are delivered by mental health clinicians in partnership with cultural brokers who are members of the refugee community they are serving and trained in TST-R, and who assist the clinical team and the community in creating cross-cultural understanding and change. The program will serve up to 250 individuals through community and parent outreach and 297 individuals in Year 1; 387 people in Year 2; 477 in Year 3; and 567 in Year 5; for a total and 2,175 over five years, with 514 in direct care, 678 in behavioral health homes, and 736 in school groups. Project goals include increasing access to effective trauma-focused treatment and services by refugee youth and families by providing TST-R treatment and decreasing barriers to mental health services; improving school functioning for refugee youth; and improving mental health and overall functioning for refugee youth with significant trauma-related mental health symptoms. ShifaME will maximize community impact by expanding its breadth of services, cultural competency, and sustainability, and establish the program as a regional hub for TST-R expertise by developing a train-the-trainer model and curriculum for TST-R training. ShifaME will increase awareness of the need for mental health services and acceptance of services by providing linguistically and culturally responsive care facilitated by cultural brokers, improving mental health and school functioning.

The Wabanaki 988 Tribal Response Project that will serve the five Maine Wabanaki Tribal communities and their members. WPHW has identified three goals for the project (1) Ensure Wabanaki tribal people have access to culturally competent, trained 988 crisis center and Care Line support; (2) Improve the integration and support of 988 crisis centers, Wabanaki Care Line, and our Tribal organizations to ensure there is smooth and effective navigation and follow-up care; and (3) Facilitate collaborations with our Tribal and state health providers, law enforcement, and other first responders in a manner which respects Wabanaki tribal culture. During the grant period, the Wabanaki 988 Tribal response Project will serve approximately 2,000 individual 988 callers and 140 training attendees. Maine’s tribal population is approximately 13,000 people, with most living on or near one of the 5 reservations spread over three large rural counties. The majority are under 35 years of age; a reflection of a high birth rate, and a much shorter life span. Life expectancy is roughly 55 years, compared to 79 years for other Mainers. They have a higher rate of disability; 32.2% of working-aged AI/AN in Maine reported having a disability as compared to 14.7% for the general population. 23% of tribal members report making less than $10,000/year with a median income of $15,540 as compared to the 2019 average per capita in Maine of $32,637. Educational attainment is less than other Mainers, with less than an estimated 50% of tribal members receiving a high school diploma or equivalent. Objectives for Goal 1: Objective 1.1: WPHW will complete a tribal readiness or needs assessment based on the most current epidemiological data to identify and prioritize the gaps in crisis response services for Wabanaki tribal communities; Objective 1.2: WPHW will develop a comprehensive strategic plan to address the gaps in Maine crisis response services related to the Wabanaki tribal communities it serves; Objective 1.3: WPHW will increase access to culturally competent crisis support by providing orientation training materials to 988 crisis center staff: an overview of the Wabanaki Communities of Maine and PH needs; and Objective 1.4: WPHW will recruit and hire a GPRA data entry specialist to allow for more efficient processing of GPRA forms. Objectives for Goal 2: Objective 2.1: WPHW will submit a quality improvement plan developed collaboratively with the Maine Crisis Line (MCL) centers that will focus on policies, first contact, assessment, referral, and access to local and tribal care that is culturally relevant and sensitive to ensure there is a comprehensive and coordinated response for tribal individuals at imminent risk for suicide; Objective 2.2: WPHW will begin implementing the improvement plan; Objective 2.3: WPHW will develop a printed resource guide listing tribe-specific community resources that can be utilized by MCL and Wabanaki Care Line staff to ensure the seamless provision of care via service referrals; Objective 2.4: WPHW will develop policies to bridge peer center and Wabanaki Care Line peer support; and Objective 2.5: Within 2 years of award, WPHW will provide at least 2 National Alliance on Mental Illness (NAMI) trainings for all 5 tribal communities. At least 14 tribal individuals will be at each training. Lastly, objectives for Goal 3: Objective 3.1: Establish and collaborate with the Maine Crisis Line centers and the Wabanaki Care Line center to improve effective 988 response and linkage to local and tribal resources, including cases of emergency intervention; Objective 3.2: Within 120 days of award, WPHW will deliver training for Maine Crisis Line center staff that specifically addresses tribal cultural needs and sensitivities when responding to tribal individuals; and Objective 3.3: Within 180 days of award, WPHW will develop a plan for sustaining collaboration with MCL centers after the grant period, by developing a MOU.