NH Discretionary Funding Fiscal Year 2018

The Monadnock Region System of Care project is a comprehensive regional plan to improve the behavioral health outcomes of children and youth with serious emotional disturbance by building and engaging infrastructure capacity to create a comprehensive system of care approach and implement wraparound. We will impact up to 4,827 youth in the Region estimated to have a mental disorder; wraparound will serve 35-45 annually, 140-180 total. Key project objectives include creating a governance board, meaningfully involving families and youth at the policy and system level and in the planning and delivery of services, training the workforce on system of care, creating partnerships between providers and with related initiatives, creating peer support services, broadening the array of available services and supports, and creating a care management structure to implement wraparound. This plan is youth-guided, family-driven, community-based, collaborative and culturally and linguistically appropriate for our community.

Population to be served and need: The proposed 3-year Upstream project will target health (e.g., pediatricians, nurses, adult addiction providers) and service providers (e.g., police, fire, and emergency services; military/National Guard members; child advocates; child-care/pre-school staff; homeless shelters) serving children ages 0 to 6 years and their families. The catchment area encompasses three primarily rural counties across New Hampshire and Vermont known as the “Upper Valley.” The population is largely Caucasian, and many towns suffer from higher than average poverty and unemployment levels. The targeted counties are in the midst of a devastating opioid crisis with some of the highest overdose death rates and infants born addicted to opioids in the country. Numerous service sectors have observed an unprecedented increase in early childhood neglect and trauma and subsequent mental health needs of young children. For example, the number of children entering foster care has risen 30% since 2012, mostly accounted for by infants and young children. Health, community, and service providers are overwhelmed by the influx of needs in this population and are unfamiliar with how to identify mental health needs in young children. Yet early intervention is key to preventing the long-term effects of adversity during this rapid period of brain development and growth. Strategies/evidence-based practices: The Upstream project will provide evidence-based mental health and trauma training and consultation to health, community, and service professionals serving young children and families across the Upper Valley. We will use standardized, evidence-based curricula focused on identifying signs of trauma, neglect, and mental health symptoms in children ages 0 to 6 years and de-escalation strategies for dysregulated individuals; as well as processes and tools to facilitate referrals to partnering mental health agencies providing evidence-based psychotherapy to this population in our community. Trainees will also have access to the Upstream consultation program connecting them with 1 of 3 local early childhood expert mental health clinicians via in-person and phone consultation to assist with the identification of children in need and linkage to treatment. Goals and measurable objectives: Our goal is to increase the capacity for health, community, and service professionals to identify trauma and mental health needs in young children and link families to needed services. Our primary objectives are to provide six full-day and three 2-hour sequenced in-person trainings (54 total training hours; 18 annually) to 300 professionals (100 annually) spanning numerous disciplines across the Upper Valley; provide ongoing in-person or phone consultation through county-based early childhood experts; and increase the number of referrals from the trained professionals to the partnering mental health agencies.

Through the Crisis Intervention Training for New Hampshire’s First Responders Project, NAMI New Hampshire and its partners will train 435 NH State Police (NHSP) and Fire/Emergency Medical Services personnel (Fire/EMS) to recognize signs and symptoms of mental illness, provide them with the skills to effectively de-escalate situations and make appropriate referrals to community mental health services in order to ensure the safety of individuals with mental illness, First Responders and the general public. The population to be served are individuals with mental illness, or those experiencing a mental health crisis, who come into contact with NHSP and Fire/EMS. In any given year, 1 in 5 Granite Staters has a mental illness – approximately 260,000 individuals. Strategies include two practices: The Crisis Intervention Team (CIT) Model is a 40-hour best practice training that helps First Responders recognize the signs and symptoms of mental illnesses; safety de-escalate individuals experiencing mental health crises; and utilize community mental health services and diversion strategies to provide assistance. Mental Health First Aid for Public Safety (MHFA-PS) is an 8-hour evidence-based practice training for First Responders that helps them better understand mental illnesses and provides them with effective strategies to de-escalate situations involving psychiatric crises. Goals and outcomes: Goal 1) Improve First Responder, consumer and public safety when responding to calls involving individuals with mental illness. Objective 1a) By September 30 of each of the three project years, partners will have trained 75 NHSP Troopers and 20 Fire/EMS providers in the 40-hour, evidence-based, Crisis Intervention Team model. Objective 1b) By September 30 of each of the three project years, partners will have trained 50 Fire/EMS providers in the 8-hour, evidence-based, Mental Health First Aid for Public Safety (MHFA-PS). Goal 2) Implement a community-oriented collaborative model for responding to individuals in psychiatric crisis that will improve individual outcomes, reduce arrests and incarceration, as well as avoid more costly interventions through timely referrals to community-based treatment. Objective 2a) By December 1, 2018, convene the NH Crisis Intervention Project Steering Committee comprised of representatives of the project partners including NHSP, Fire/EMS, NH Community Behavioral Health Association, Granite State Critical Incidence Stress Management Team, NAMI New Hampshire, and the NH Bureau of Mental Health Services. Objective 2b) By February 1, 2019, project partners will have established pathways for First Responders who are trained in CIT and MHFA-PS to refer individuals with mental illness with whom they interact to community mental health services. Goal 3) Evaluate project activities to ensure training is effective and appropriate referrals to mental health or related services are made trained NHSP Troopers and Fire/EMS providers. Objective 3a) By February 1, 2019, project partners will begin to implement appropriate evaluation of CIT and MHFA-PS trainings to ensure effectiveness and fidelity to the practices. Objective 3b) By February 1, 2019, CIT and MHFA-PS trainees will begin reporting the number of individuals referred to mental health or related services to Project Evaluator. Annually, 145 First Responders will be trained. A total of 435 First Responders will be trained throughout the 3-year project period.

NAMI New Hampshire (National Alliance on Mental Illness) will provide New Hampshire families and youth with serious emotional disturbances (SED) with the framework and infrastructure (the New Hampshire Family Network) to improve outcomes for children/youth with SED and transform the state's children's behavioral health system to ultimately create improved population health outcomes. The project will serve parents/caregivers of children/youth with SED, as well as youth/young adults living with SED up to age 26, if they are transitioning to an individual service plan (ISP) in the adult mental health system. Activities will be designed to address behavioral health issues specific to New Hampshire families: substance misuse, needs of military families, suicide risk that children/youth with SED face, increased risk for depression and suicide among LGBTQ youth, and unique needs of New Hampshire's minority and refugee populations.

New Hampshire Dept. of Education NH Families and Systems Together (FAST) Forward for Children and Youth 2020 will support the expansion and sustainability of a state level system of care (SOC) for children, youth, and their families. The resulting infrastructure will expand the array of supports for children/- youth with a diagnosable serious emotional disturbance (SED) who are involved with two or more systems and who are at-risk for out-of-home placement. NH FAST Forward 2020 will serve children and youth aged 0-21with an emotional, socio-emotional, behavioral or mental health disorder diagnosable under the DSMV who meet the criteria for SED and their families. The catchment area of this project is statewide.

Young people with SED and SMI exhibit high rates of health conditions and behaviors that lead to disparate morbidity and early mortality in people with SMI. For example, about half of young people have prehypertension or hypertension (high blood pressure), over half had abnormal lipids (cholesterol or triglycerides), about half are overweight or obese, and about half of this group smokes cigarettes. All of these problems contribute to the development of future chronic diseases and early mortality, but could be prevented or managed to reduce risk for future disease. The purpose of this proposed project is to improve the health and wellness of young people with SED and SMI in New Hampshire in order to prevent the health inequities experienced by this group. We will provide Health Homes – integrated physical health and wellness care combined with comprehensive behavioral health care in the community mental health center setting. Health Homes will provide integrated care for young people ages 16-35 with SED and SMI, with screening, detection and treatment of physical health conditions in concert with comprehensive, evidence-based behavioral health care. Mentors and coaches will implement an evidence-based wellness program that incorporates technology and incentives to improve nutrition and fitness and reduce weight and smoking while at the same time improving community integration, connectedness and positive identity. A peer – driven prevention program will avert smoking in those who haven’t started. We will provide this service within three partnerships between Community Mental Health Centers (primary contractor) and Federally Qualified Health Centers, in high-need regions covering 20% of the population of New Hampshire.

Riverbend Community Mental Health (Riverbend) in Merrimack County, New Hampshire (NH) will integrate primary health care services and wellness activities within its community-based behavioral health center in Concord, NH and create a culturally competent and person-centered health home to be called Riverbend's Integrated Center for Health (RICH). The goal is to improve the physical health status of the population of focus: adults with serious mental illness (SMI) and those with co-occurring substance use disorders in Merrimack County who have or are at risk for co-morbid primary care conditions and chronic diseases. Emphasis will be on 1) those who have no Primary Care Provider (PCP) or who have a PCP but don't follow through with appointments or otherwise have poor management of any chronic metabolic disease or health conditions, including those with histories of trauma, and 2) those with severe psychotic or major mood disorders or those who are otherwise extremely disorganized/impaired as a direct result of their SMI such that symptoms get in the way of: understanding physical health needs, engaging in preventive care, negotiating public transportation, interpersonal effectiveness, and follow up activities (such as lab work) and keeping a calendar, and 3) those who would benefit from Wellness Activities to support improved health and functioning. Services will be delivered to: 100 clients in Year 1, 250 clients in Year 2, 400 clients in Year 3, and 500 clients in Year 4.

The goals of the CAST Coalition are to establish and strengthen community collaboration in support of local efforts to prevention youth substance misuse. The Coalition will achieve its goals by implementing the following strategies: 1) Provide information and enhance skills of Souhegan Valley community stakeholders relative to improving public health 2) Provide support and enhance access/reduce barriers to community members to participate in coalition capacity building activities 3) Advocate for and modify policies to increase the coalition's cultural competency to meet the needs of the community 4) Provide information, enhance skills, and provide support to raise the perception of risk of substance misuse in Souhegan Valley 5) Enhance skills, provide support, reduce access, change consequences, and modify/change policies to increase messaging promoting positive social norms for youth and adults in Souhegan Valley 6) Provide information, enhance skills, and reduce barriers to increase the level of parental disapproval of youth substance misuse

Dover Coalition for Youths STOP Act Grant Project

The City of Dover, New Hampshire plans to prevent and reduce the abuse of opioids or methamphetamines and the abuse of prescription medications among youth ages 12-18 in our local community. This will be accomplished by the Dover Coalition for Youth using a variety of strategies including policy change, providing information to stakeholders and the public, enhancing skills and reducing various barriers. The project, The City of Dover's CARA grant to prevent and reduce the abuse of opioids or methamphetamines and the abuse of prescription medications among youth ages 12-18, will serve youths, teachers, school staff, medical prescribers, and parents/other adults in the community. We expect to serve approximately 3800 people annually and over 10,000 during the life of the project. Specifically, we plan to enhance the ability of the Coalition to create community-level change regarding opioids and the misuse of prescription medications by increasing knowledge of coalition staff and members by having 80% of members reporting that they are knowledgeable or very knowledgeable about opioid/Rx misuse on the annual coalition member survey by June 1, 2019. Also, by June 1, 2019 we will enhance intergovernmental cooperation and coordination on the issue of opioids and the misuse of prescription medications among school-age youth by formalizing communication of such issues between the police and schools. This project will also reduce youth prescription drug and opioid misuse by addressing the factors in the community that increase the risk of substance misuse and promoting the factors that minimize the risk of substance abuse and opioid misuse by addressing the factors in the community that increase the risk of substance misuse and promoting the factors that minimize the risk of substance abuse. We plan to increase the perception of risk of prescription drug and opioid misuse among Dover youth in grades 7-12 from 91% to 94% among middle school and 88% to 90% among high school students, by June 1, 2019. By June 1, 2019, we hope to increase the perception of peer disapproval of prescription drug/opioid misuse among youth in grades 7-12 from 94% to 96% in middle school and 82% to 88% in high school. We plan to increase the perception that parents disapprove of prescription drug/opioid misuse from 97% in middle school and 94% in high school to 98% in all grades, by June 1, 2019. We expect to decrease the rate at which youth report it is easy to access prescription drug/opioids from 63% in high school to 70%, by June 1, 2019. We also plan to increase the number of prescribers utilizing the NH Prescription Drug Monitoring Program in Strafford County by 10 percent, as measured by the state PDMP program manager, by June 1, 2019.The strategies that we will use to achieve these goals are policy change, providing information/enhancing skills, and enhancing access/reducing barriers.