NC Discretionary Funding Fiscal Year 2018

The Center for Child and Family Health's (CCFH) Project Connect: Promoting Recovery from Childhood Trauma will increase access to and improve the quality of trauma-focused treatments and services for children, adolescents, and their families who experience traumatic events. CCFH targets youth from birth to 21 and their families who are affected by trauma and psychosocial adversity.

Project Connect will (1) increase access to and use of trauma treatment in the CCFH outpatient clinic for children and families through use of engagement strategies; (2) provide a more comprehensive array of direct outpatient evidence-based trauma-informed treatments and services for children and adolescents and their caregivers using current treatment models
to reduce trauma and mental health symptoms in 370 children and caregivers annually; (3) enhance screening and assessment of children and their caregivers for the presence of co-occurring mental and substance use disorders, serving 1,485 additional children and caregivers annually; (4) provide training on trauma-informed practices to child-serving service systems, training at least 170 professionals, resource parents, and graduate students; (5) enhance sustainability of trauma efforts beyond SAMHSA grant funding by collaborating with NC Division of Social Services, NC Division of Mental Health, and local MCO management to address policy and fiscal opportunities and challenges; and (6) raise the standard of care and improve access to services for traumatized children, families, and communities locally and nationally through participation in SAMHSA and NCTSN activities (e.g., workgroups, committees, collaborations with TSA and CTS centers) and meet all NOMS and IPP goals. Taken together, these Project Connect activities will benefit 1,855 unduplicated children and caregivers annually, for a total of 9,275 individuals over the course of the project.

Char-Meck ReCAST (CMR) seeks to improve resilience and healing among high-risk youth and families in Charlotte-Mecklenburg County, NC by: (i) increasing trust and healing between government organizations and communities of color; (ii) increasing culturally sensitive, trauma-informed services; and (iii) addressing key social determinants underlying the recent civil unrest, following the shooting deaths of two African American men in our community. Racial disparities in employment and education have created isolated areas of poverty in Charlotte-Mecklenburg, especially for African Americans. The unemployment rate of African Americans (14%) is more than twice that of whites (6%). The median household income of whites is 86% higher than that of African Americans; and shockingly, the poverty rate for African American children (39%) is eight-times higher than for white children (5%). These conditions can produce traumatic events for children, including victimization and exposure to violence. Nearly a quarter of adolescents in the community experience at least one traumatic event in their lifetime . The community offers services (including mental health services) that can address the consequences of racialized poverty. These service organizations are not always trained to deliver culturally sensitive, trauma-informed care to marginalized groups. The community also lacks an organized framework that ties these services together in a way that facilitates sustainable change among high-risk youth and their families. Char-Meck ReCAST will address these issues by implementing evidence-based, violence prevention programs for youth and establishing linkages to trauma-informed (TI) behavioral health services. Specifically CMR will: (i) create a youth advisory body to develop a strategic plan; (ii) conduct broad-based trauma-informed (TI) training and TI peer support training for youth; (iii) integrate neighborhood patrol officers into youth/community activities; (iv) create a TI information communication plan/website; and, (5) increase our community’s Rapid Response capabilities. Key outcome measures will be determined through the planning process, but will be designed to measure progressive change in youth; changes in family perceptions regarding police-community relations; and access to TI healing services. When fully implemented, Char-Meck ReCAST will reach over 147,000 children within the Charlotte-Mecklenburg Schools. 1. NC Poverty Research Fund (2016). Economic Hardship, Racialized Concentrated Poverty, and the Challenges of Low-Wage Work: Charlotte, North Carolina. 2. Costello, E. J., Erkanli, A., Fairbank, J. A., & Angold, A. (2002). The prevalence of potentially traumatic events in childhood and adolescence. Journal of traumatic stress, 15(2), 99-112.

The Family Centered Treatment Foundation (FCTF) is the nationally recognized provider of the evidence-based Family Centered Treatment (FCT). The primary purpose of the Family Centered Treatment – Trauma Series Project (FCT-TS) Project is to enhance evidenced-based family-systems trauma treatment and increase access to its availability to ensure high-quality treatment for families from a wide range of populations across diverse geographic regions in the U.S. The NREPP registered FCT model has a strong trauma focus embedded both in the theoretical framework and design and in the practical application. FCT draws on two primary evidenced-based theoretical models of family-based treatment including eco-structural family therapy and emotionally-focused therapy, which focus on strengthening attachment and changing the emotional tone and patterns of interactions among family members. The service delivery system of FCT includes the public sectors of child welfare, juvenile justice, mental health, and substance abuse. Male and female populations of all ages are included with histories or current involvement in Mental Health, Substance Abuse, Developmental Disabilities, Juvenile Justice systems, including “crossover youth” engaged in multiple systems, military families, families living in impoverished and high-risk communities. The FCT model recognizes the importance of having a cultural and contextual understanding to the traumatic experiences of youth and their families in order to effectively treat all populations, including disadvantaged groups disproportionately affected by trauma; however, few models are designed to treat trauma within the context of the family and not all are available to particularly disadvantaged and underserved populations and/or address a wide range of traumatic experiences. Thus, the goals of the project are to 1) enhance and expand FCT to better serve families of complex trauma; 2) Extend the access to FCT for families/victims of complex trauma in the identified states and additional states; and 3) advance the awareness and access of FCT nationally for trauma centers. These goals will be achieved through the following objectives: 1) enhance the FCT comprehensive online, field- based, competency training and certification program to include trauma treatment modifications suggested by Richard Kagan of Real Life Heroes and NCTSN (obtained from a previous evaluation); 2) Increase availability of trauma treatment by expansion of providers FCT (over 9 states, over 40 site locations, and 400-600 FCT personnel over the course of the project period); and 3) engage in national participation in leadership development for agencies providing trauma treatment and increase the advancement of trauma treatment for the family system through evidenced-based and home-based treatment, including leadership development and support for the 25 NCTSN Category II awardee sites. Expanding availability and implementation of trauma treatment through training programs to current FCT sites are expected to incrementally impact 1,440 families annually in 9 states and expanding training programs to additional sites and states serving 7,200 families over the course of the project.

Health Education for Advanced Living (HEAL) Project Abstract Johnson C. Smith University (JCSU) and Anuvia Prevention and Recovery Center (APRC) are partnering in their effort to provide the Health Education for Advanced Living (HEAL) Project. This effort will provide Mental Health Awareness Training (MHAT) and related referral support services for at least 600 mental health workers, school personnel, emergency first responders, law enforcement, veterans, armed services members and their families, and others who come in contact with the citizens of Mecklenburg County. The HEAL Project will provide MHAT for a minimum of 200 mental health workers and other individuals annually. Instruction will be offered utilizing the evidence-based Mental Health First Aid Training Program through an 8-hour training course at either the project partner location or at the office of the company being trained. The program objectives are: 1) By the end of each project year to train at least 200 targeted mental health workers and other individuals to recognize the signs and symptoms of mental disorders, particularly serious mental illness and serious emotional disturbance. 2) By the end of each project year to establish or maintain linkages with school and community based mental health agencies to refer individuals with the signs or symptoms of mental illness to appropriate services. 3) By the end of each project year to train at least 200 targeted mental health workers and other individuals to employ crisis de-escalation techniques with the individuals they have identified with mental disorders. 4) By the end of each project year to educate and follow up at least 200 MHAT trained mental health workers and other targeted individuals about resources that are available in the community for individuals with a mental disorder. JCSU, the lead agency, and APRC have been responding to the needs of at-risk populations in the Charlotte metropolitan area for many years. APRC will be the primary mental health treatment location for the individuals referred by HEAL project trainees. HEAL staff members will include a part-time project director who will supervise the overall project, and act as the primary contact with the federal funding source. A part-time project coordinator will assist with training and follow up on all referrals made to the project to help facilitate treatment and address issues. A part-time project liaison who will develop and maintain relationships with local stakeholders. The project will also include a mental health licensed professional to provide the MHFA Training. An independent evaluator will be contracted to collect performance data and assess completion of project objectives. 1

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With this project, Lincoln Community Health Center, Inc. (LCHC), a HRSA federally qualified health center and Ryan White Part C provider, will integrate evidence-based, culturally competent mental and substance use disorder treatment with HIV primary care and prevention services. The project will focus on individuals with SMI or COD living with or at risk for HIV and/or hepatitis in at-risk populations, including racial and ethnic minority communities. Project Name: Minority AIDS Initiative-Service Integration for Behavioral Health and HIV/Hepatitis Prevention in Durham County. Target Population: The populations of focus for the project are Durham County residents with an SMI or COD who are currently enrolled in agencies contracted by the region's managed care entity for behavioral health to deliver safety net services; clients receiving care through Durham County Department of Public Health (DPH); LCHC clients; and residents of targeted racial and ethnic communities who may not currently be enrolled in the system of care but are at risk for HIV and/or hepatitis. This includes African Americans, Hispanics, MSM, IDU, homeless, and people born from 1945-65. Strategies and Interventions: This project will allow LCHC to provide HIV and hepatitis prevention services in a behavioral health setting, expand and implement evidence-based mental health and substance use disorder treatment that is trauma-informed and recovery-oriented (including screening patients for ACEs and implementing Seeking Safety, an evidence-based, present-focused counseling model designed to help people attain safety from trauma and/or substance abuse), implement outreach strategies to inform individuals of available behavioral health services and HIV and hepatitis primary care and prevention services, and to provide peer support services and case management services to coordinate all aspect of care. Project Goals and Measurable Objectives: The project has established measureable objectives to meet the following goals: 1) increase the capacity of the local safety network to reduce the incidence of HIV and hepatitis among people with SMI or COD who are at risk for HIV and/or hepatitis, 2) improve the capacity of LCHC to treat people with SMI or COD who are living with or at risk for HIV and/or hepatitis, and 3) evaluate and sustain the evidence-based, culturally competent model of care. The project will serve 150 patients in Y1 and 300 annually thereafter with Seeking Safety (1,050 over the 4-year project period); 250 clients in Y1 and 500 annually thereafter with peer education and case management (1,750 over the project period); 500 clients in Y1, and 1,000 annually thereafter with outreach including HIV and hepatitis prevention services (3,500 over the project period). The total number of unduplicated clients is estimated at 3,500.

Metropolitan Community Health Services (MCHS), a 501(c)(3) non-profit Federally Qualified Health Center (FQHC), is applying for the Mental Health Awareness Training Grant to increase mental health awareness and train populations in rural eastern North Carolina on how to appropriately and safely respond to individuals with mental disorders, particularly individuals with serious mental illness (SMI) and/or serious emotional disturbance (SED). OVERVIEW OF MCHS: MCHS provides mental health services as well as primary and preventive medical, dental, pharmacy, behavioral health, and substance abuse services to vulnerable and indigent populations in eastern North Carolina on a sliding fee scale. MCHS serves the rural counties of Beaufort, Hyde, Martin, Tyrell, and Washington in North Carolina. PROJECT NAME: Mental Health Awareness Training Project in Rural Eastern North Carolina POPULATIONS TO BE SERVED: MCHS will serve populations throughout its five-county service area, with a focus on vulnerable, low-income, and uninsured populations; these counties share significant health care, economic, geographic, and educational challenges. According to the Uniform Data System Mapper Report of MCHS’s service area, 43% of the population are low-income residents with incomes under 200% of the Federal Poverty Level, 22% live in poverty, and 11% are uninsured. According to the Robert Wood Johnson Foundation, all of the counties in MCHS’s service area have numerous core health indicators that are worse than those of the state of North Carolina. In these counties, the average number of poor mental health days is worse than the state’s average, the percentage of the population reporting frequent mental distress of 14 or more days each month ranged from 12% to 13%, and there are high suicide rates. The need for awareness of and referral to mental health services is exacerbated as all five counties are designated by HRSA as Health Professional Shortage Areas (HPSAs) for mental health. STRATEGIES & INTERVENTIONS: MCHS plans to hire a 1.0 FTE Project Manager/Trainer and a 0.5 FTE Trainer to: 1) provide Mental Health First Aid (MHFA) training to individuals (e.g., school personnel, emergency first responders, law enforcement, veterans, armed services members and their families) to recognize the signs and symptoms of mental disorders, particularly SMI and/or SED; 2) establish linkages with school- and community-based mental health agencies to refer individuals with the signs or symptoms of mental illness to appropriate services; 3) provide Crisis Intervention Training (CIT) to emergency services personnel, veterans, law enforcement, fire department personnel, and others to identify persons with a mental disorder and employ crisis de-escalation techniques; and 4) educate individuals about resources that are available in the community for individuals with a mental disorder. PROJECT GOALS FOR MCHS’S SERVICE AREA: To increase mental health awareness; to increase referrals of individuals with the signs or symptoms of mental illness to appropriate services; and to increase the appropriate utilization of crisis de-escalation techniques for persons with mental disorders. OBJECTIVES: To provide MHFA training to 333 individuals annually and 1,000 individuals throughout the lifetime of the project; to establish linkages with 12 school- and community-based mental health agencies to refer individuals with the signs or symptoms of mental illness to appropriate services; to increase the number of referrals of individuals with the signs or symptoms of mental illness to appropriate services to 125 individuals annually and 375 individuals throughout the lifetime of the project; and to provide CIT training to 100 individuals annually and 300 individuals throughout the lifetime of the project to identify persons with a mental disorder and employ crisis de-escalation techniques.

Summary: Monarch's CCBHC Expansion Project will increase the depth and breadth of mental health and substance use disorder services in rural North Carolina. As part of the project, Monarch will become CCBHC-certified within four months of award notification and will implement evidence-based interventions, case management/care coordination services and peer/family support services. Project Name: Monarch's CCBHC Expansion Project Population Served: The target population includes adults with serious mental illness (SMI), children with serious emotional disorders (SED), adults with substance use disorders (SUD) and adults with co-occurring disorders (COD). Number Served: Monarch projects it will serve more than 1,500 people annually and a total of 2,252 unduplicated individuals over the lifetime of this two-year CCBHC expansion project. Strategies/Interventions: Monarch will provide comprehensive, integrated care that directly addresses behavioral health issues; chronic health conditions (e.g. diabetes and heart disease); and adverse childhood/lifetime events such as physical abuse, hunger, poverty, and homelessness which impact treatment, recovery and overall health. Project Goals/Measurable Objectives: 1) Address the critical behavioral health needs of children and youth by increasing community outreach efforts; 2) Implement innovative substance abuse programs and/or evidence-informed practices to treat SUD; 3) Implement strategies that contribute to the physical and mental health of people supported; 4) Collaborate with local formal, informal and community supports to address the social and environmental factors that negatively impact health of people supported. Objectives include: 1) Contact 50% of Stanly County Schools in year one to increase awareness of its array of mental health and substance abuse services; 2) Educate youth and families on mental health and substance abuse-related topics through a variety of community programs at least four times annually; 3) Launch Medication-Assisted Treatment with up to 30 people supported at any given time in year one, as outlined by DATA 2000 Waiver requirements; 4) Incorporate the Integrated Dual Diagnosis Treatment EBP with a score of 3.0 on the DDCMHT Index in year one; 5) Establish cooperative relationships with three types of community physical health providers including private clinics, public health organizations and local hospitals; 6) Implement at least two new technologies that support care delivery and coordination such as electronic health record enhancements, health information exchange access, improved telehealth capabilities; 7) Expand electronic resource database to include resources specific to the four primary social determinants of health domains (SDOH); 8) Implement an electronic Social Determinants of Health screening instrument.

The National Board for Certified Counselors (NBCC) Foundation proposes to continue the Minority Fellowship Program for Mental Health Counselors (MFP-MHC). The MFP-MHC will improve the quality and quantity of services for racial and ethnic minority populations by supporting post-baccalaureate training for mental health counseling professionals. The goals of the MFP-MHC are: 1) to increase the number of culturally competent mental health counseling professionals who teach, administer services, conduct research, and provide direct mental health counseling services to racial and ethnic minority populations; and 2) increase the knowledge of mental health counseling professionals on issues related to prevention, treatment, and recovery support for individuals who are from racial and ethnic minority populations and have a mental health disorder. The MFP-MHC will target underrepresented students and will encourage specialization in mental health counseling services to underserved minority communities, particularly people with serious mental illness/serious emotional disturbance; child/adolescent and geriatric groups; minority communities in inner cities and rural areas; minority persons including LGBT; and those who are veterans or are from military families. The MFP-MHC will use federal funds to support master’s-level degree stipends, doctoral-level degree stipends, infrastructure development and behavioral health care specialty training. Annually 30 fellowships will be awarded to master’s-level mental health counselors-in-training and 20 fellowships to doctoral level counselor educators-in-training at accredited institutions. Specialty training will be provided to an additional 1000 mental health counseling professionals. The MFP-MHC will assure that 60% of fellows graduate within 2 years of the fellowship award and 90% graduate within 3 years of the fellowship award. Further, 85% of fellows will be employed as mental health counselors or counselor educators increasing services to racial and ethnic minority communities within 1 year of graduation. Over the proposed 5 year period, 250 fellowships will increase the workforce and 5000 working professionals will be better prepared to provide mental health counseling services to racial and ethnic minority communities.

The National Board for Certified Counselors (NBCC) Foundation, in partnership with NAADAC, the Association for Addictions Professionals, proposes to continue the Minority Fellowship Program for Addictions Counselors (MFP-AC). The MFP-AC will improve the quality and quantity of services for racial and ethnic minority populations by supporting post-baccalaureate training for substance use disorder and addictions counseling professionals. The goals of the MFP-AC are: 1) to increase the number of culturally competent substance use disorder professionals who teach, administer services, conduct research, and provide direct substance use disorder services to racial and ethnic minority populations; and 2) increase the knowledge of substance use disorder behavioral health professionals on issues related to prevention, treatment, and recovery support for individuals who are from racial and ethnic minority populations and have a substance use disorder. The MFP-AC will target underrepresented students and will encourage an increased number of all counselors-in-training to specialize in addictions/substance abuse services to underserved minority communities, particularly people with serious mental illness/serious emotional disturbance; child/adolescent and geriatric groups; minority communities in inner cities and rural areas; minority persons including LGBT; and those who are veterans or are from military families. The MFP-AC will use federal funds to support master’s-level degree stipends, infrastructure development and behavioral health care specialty training. Annually 40 fellowships will be awarded to master’s-level addictions counselors-in-training at accredited institutions and specialty training will be provided to 1000 other substance use disorder behavioral health professionals. The MFP-AC will assure that 60% of fellows graduate within 2 years of the fellowship award and 90% graduate within 3 years of the fellowship award. Further, 85% of fellows will be employed as substance use disorder professionals serving racial and ethnic minority communities within 1 year of graduation. Over the proposed 5 year period, 200 fellowships will increase the workforce and 5000 working professionals will be better prepared to provide substance use disorder services to racial and ethnic minority communities.