MO Discretionary Funding Fiscal Year 2017

The St. Louis Regional System of Care is a collaborative effort to build meaningful partnerships with families, youth and public/private child serving agencies, and community based organizations to provide culturally competent services and supports for all children from birth to age 21 with or at risk of developing an SED to enable them to function successfully in their homes, schools, communities, and throughout life. STL-SOC is committed to a paradigm shift in children's mental health service delivery that institutionalizes a collaborative approach and fundamentally changes the way we do business.

The Greene County Youth Mental Health First Aid (YMHFA) Implementation Project will saturate the community of Greene County, Missouri with YMHFA First Aiders, who will in turn serve the population of youth ages 12-18. There will be three groups of activities, including Infrastructure Development, Training and Technical Assistance, and Community Outreach and Education. Objectives include increasing the mental health literacy of adults who interact with adolescents, conducting outreach and engagement strategies with adolescents and their families or caregivers to increase awareness of and promote positive behavioral health, linking adolescents with behavioral health issues to appropriate assistance and services, and increasing the number of collaborative partnerships with relevant youth-serving community agencies and programs. This project will serve at least 25 new YMHFA Facilitators who will train 2,700 YMHFA First Aiders throughout the three year project, with 600 First Aiders in Year One, 1,000 First Aiders in Year Two and 1,100 First Aiders in Year Three. The success of this project will be determined by the successful training of YMHFA Facilitators, the training of 2,700 YHMFA First Aiders, and the number of youth who receive the help needed through referral to resources and services by YMHFA Facilitators and First Aiders.

The Show Me Zero Youth Suicide Initiative aims to reduce youth suicide through an integrated systems-level approach, which includes establishing a continuity of care model for youth at risk of suicide and promoting the adoption of suicide prevention as a core priority of youth-serving institutions, such as hospitals and schools. Through collaboration with these organizations, this initiative will effectively identify youth ages 10-24 who are at risk for suicide and provide immediate linkage to intensive services and follow-up care. An innovative data-driven surveillance system will document whether services reduce suicidal behaviors. Services will be focused on a five-county region in western Missouri, centered on Jackson County, which includes Kansas City, as well as surrounding counties with more rural areas. The region has higher rates of youth suicide, suicidal ideation, and intentional self-injury than Missouri averages. A multi-pronged approach will promote and support sustainable systems level change while employing strategies from the 2012 National Strategy for Suicide Prevention that focus on treatment and support services. The initiative will place special emphasis on those at higher risk for suicide, including youth who have previously attempted suicide, 18-24 year old youth, and lesbian, gay, bisexual, transgender and questioning youth. The overall aim of the Show Me Zero Youth Suicide Initiative is to reduce suicides and suicide attempts by accomplishing three major goals: 1) Improve the system of care for suicidal youth who use hospital emergency departments, in-patient psychiatric facilities, and/or crisis hotlines. 2) Improve the capacity of school systems to identify, respond, and refer youth at risk of suicide. 3) Strengthen overall prevention efforts for at-risk youth populations in other settings. This initiative will provide direct services to 2,000 individuals in year one and increase annually, serving 15,000 over the grant period, with

System of Care Community Enhancement for Early Signs and Symptoms (SOC-CESS) is a widespread expansion of an enhanced System of Care (SOC) that will improve outcomes for youth, ages 9-17, and their families affected by, or at risk of, early onset psychosis. As a result, local SOC communities will provide specialized surveillance, early detection, research-based treatment, family driven/youth guided participation at all levels within a community network. SOC-CESS will: 1) Improve the health and psychosocial functioning of youth who are at risk of early onset psychosis and their families, 2) Embed family and youth leadership within local and state agencies, and 3) Expand an enhanced SOC specifically as it relates to early identification and treatment for youth at risk of or experiencing early onset psychosis and their families. It is estimated that on an annual basis, SOC-CESS will serve between 150 to 200 youth who are experiencing an identified as experiencing First Episode of Psychosis, ages 9- 7. SOC-CESS could serve as many as 500 youth who are affected by or at risk of early onset of psychosis per year, which is 2,000 youth over the course of four years.

Through the Voices United for Hope, Recovery and Empowerment project, NAMI Missouri will cultivate, train, and empower new consumer leaders and expand network participation. Central to this project is the identification, training, and ongoing support of peers who will serve as mentors and new leaders. This project will have a distinct focus on military veterans and young adult consumers as well as partnership with the MO Recovery Network to increase network participation among persons recovering from substance use. The Veteran's Council will advise on matters of military culture and outreach. The NAMI On Campus groups will assist in engaging young adults and cultivating peer leaders. NAMI MO will ensure a diverse group of consumers have the opportunity to participate in the trainings which will make NAMI MO more effective as a statewide consumer network. Finally, NAMI MO will prepare consumers to play a central role in systems transformation by providing leadership and self-advocacy training and one-on-one mentoring, with targeted recruitment of MO Recovery Network members, veterans, young adults and rural consumers and consumers who are members of racial, ethnic and LGBT minority groups. Trainees with interest will be afforded opportunities and given support to serve on statewide and local system transformation coalitions, committees, councils, and workgroups.

Our proposal, Integrating Care for Health & Wellness at Places for People, will expand our current services by creating PBHCI Treatment Teams to integrate primary health care into our behavioral care services. Our purpose is to address the total health care needs of people with severe mental illness and enhance consumers' experience of care, helping them live healthier, longer lives. We further aim to increase efficiency and reduce the overall cost of health care. We will enroll 400 unduplicated persons into health and wellness services, integrating these services into our community support and ACT treatment teams to form PBHIC Treatment Teams with the addition of new health care professionals. Under this proposal, we will hire an MD Primary Health Care Consultant to consult with service teams; two LPN integrated Health Care Specialists to provide direct health interventions; and both a Peer wellness Coach and a Fitness/ Nutrition Specialist to provide individual and group counseling. We will re-assign 1.3 Nurse Care Managers from our Health Care Home to our PBHCI teams offering nursing care all service teams to focus on integrated health. PBHCI participants will be adults diagnosed with severe mental illness, many with co-occurring disorders, who receive intensive behavioral health services provided through a team approach. Places for People's clients have the most complex and challenging behavioral health needs and are unlikely to voluntarily seek health care services without significant support. We will serve 200 people Year 1; 267 Year 2; 334 Year 3 and 400 Year 4. Participants will likely be 57% male, 42.5% female, .5% transgender; 55.7% black American, 35.7% white American, 2.1% Asian, .7% non-white Hispanic, 8% refugees (multiple ethnicities/nationalities); 2.6% < 18 years, 93% between 18-64 years, 3% over 65 or older. 5% will be veteran.

Provident, Inc. will support intensive case management services for 198 Missouri adults annually that are considered at-risk for suicide due to recent suicide attempt, history of suicide attempt(s), suicidal ideation or self-injury. The program will serve Missouri adults of all genders, ethnicities, socioeconomic backgrounds, and sexual orientations. The HopeAfter Phase III program will serve a total of 594 clients over the lifetime of the project. The proposed interventions include: A) Initial and Ongoing Assessment, which cover the core principles and subcomponents of the National Suicide Prevention Lifeline (NSPL) Suicide Risk Assessment Standards, rating the client's suicidal desire, suicidal capability, suicidal intent, and buffers/connectedness. Assessments also include a PHQ9 assessment, standard mental health screening, and suicide risk assessment; B) Intensive case management services, including development of a safety plan, review of hospital discharge plan, creation of personal goals, access to care and social supports, connection with outside treatment, such as counseling, psychiatric care and/or medication, substance abuse counseling, and any other advocacy calls or activities on behalf of the consumer. Consumers will be referred from Hyland Behavioral Health at St. Anthony's, from Provident's Life Crisis Services crisis hotline, or from other area hospitals or crisis hotlines. The HopeAfter Phase II program has been in practice since July, 2013, and has demonstrated a 55 percent graduation rate. The HopeAfter Phase III program is also expected to have a 55 percent graduation rate, with graduation noted as clients exhibiting at least two of the following: ability to manage a job, completion of two personal goals, ability to avoid negative triggers, completed and followed safety plan, and improved assessment scores.

The proposed project, Housing, Employment, and Recovery Support (HERS), purpose is to provide gender-focused, comprehensive and collaborative permanent supportive housing and recovery support services to chronically homeless women and/or women with children who are homeless in the Saint Louis Metropolitan Statistical Area, who have substance use disorders (SUD) and/or co-occurring disorders (COD). The HERS project purpose will be accomplished through the provision of trauma-informed housing support, employment, and health services aimed to: reduce substance use and mental health symptoms; improve daily living; increase retention in permanent supportive housing; and increase employment and educational opportunities. Through the provision of gender-specific, culturally sensitive services which are individually tailored to maximize outcomes, it is hoped the cycle of homelessness can be broken, substance use can be reduced, and other behavioral health symptoms can be improved. In order to create sustainable change, culturally sensitive services and evidenced based practices will be offered to women who are chronically homeless and/or homeless with children. The goal of the project is to prepare and support the population of focus with the resources and skills to maintain independent community living. Annually, 100 women will be enrolled in HERS and 48 women will participate in permanent supportive housing and onsite recovery support services offered at Queen of Peace Center to include; trauma-informed housing support services, employment services, and health services offered through intensive case management, peer support, and therapeutic services.

Project CATALYST (Community Action for Trauma-informed Access, Leadership, Youth Support and Training) Summary: Project CATALYST will create an ecosystem of care to solidify, sustain and build upon community-based participatory efforts; meet the needs of high risk youth and their families; and promote well-being, resiliency and community healing. The Saint Louis County Department of Public Health (DPH) and St. Louis Regional System of Care (cross-sector coalition of partners) propose to leverage existing and emerging research, data platforms, partnerships, youth advisory bodies, strategic planning processes and community leaders to provide a cohesive, cross-jurisdictional approach. The
CATALYST Advisory Board will provide project oversight and guidance, but investments and priorities will be determined using community-based, participatory approaches (including participatory budgeting).

CATALYST Project Goals: (1) Build a foundation to promote well-being, resiliency, and community healing through service integration advised by community-based participatory approaches and the Trauma-Informed Community Building Model; (2) Improve access to trauma-informed community behavioral health resources and youth peer support; (3) Create community change through community-based participatory approaches that promote community and youth engagement, leadership development, improved governance, and capacity building.

The Ferguson Area Youth Mental Health First Aid (YMHFA) project will train 2,025 adults to recognize signs and symptoms of mental health conditions and connect youth in need to treatment and resources. Teachers, parents, law enforcement personnel, mentors, individuals from faith communities, and agency providers in Ferguson, Missouri and surrounding communities in North St. Louis County will receive YMHFA training. The project team will leverage Missouri's substantial YMHFA expertise and build a network of First Aiders to serve and support primarily African American adolescents ages 12-18 in and around Ferguson. Youth in the area are extremely vulnerable to serious mental health challenges because of poverty and racial and ethnic disparities, compounded by community violence and protests. The project's goal will be achieved through the following objectives: train 12 new YMHFA instructors from youth-serving partner organizations in the Ferguson community and surrounding areas; train 2,025 First Aiders (600 in year 1, 675 in year 2, and 750 in year 3 by conducting 81 high quality YMHFA courses in the greater-Ferguson community; and strengthen relationships with mental health service providers in the Ferguson area to facilitate youth mental health referrals. The Missouri Institute of Mental Health (MIMH) at the University of Missouri-St. Louis will serve as the lead agency in partnership with community members and three well-respected organizations including Behavioral Health Response, Big Brothers Big Sisters of Eastern Missouri, and Great Circle.