NV Discretionary Funding Fiscal Year 2018

The College of Southern Nevada (CSN) is the only open enrollment institution in Southern Nevada. The overall objective of CSN's proposed SAMHSA MHAT project is to utilize the evidenced-based, Mental Health First Aid (MHFA) training curriculum as a avenue to assist staff members and students leaders to recognize the signs and symptoms of mental health disorders, particularly, serious mental illness (SMI) and/or serious emotional disturbance (SED) within the CSN's student body population. The College's Counseling and Psychological Services (CAPS) will serve as the lead department for this project.

The State of Nevada's Division of Child and Family Services (DCFS), as part of the Nevada Department of Health and Human Services (DHHS), provides a wide range of services for children, youth and families in Nevada. Program areas include Child Welfare, Juvenile Justice, as well as Youth Behavioral Health Services, DCFS also provides children direct services as well as oversight for the programs administered at the state and county level. In recognizing the important role the State has to protect and provide services to Nevada's vulnerable children, the Governor and Legislator passed Nevada Revised Statute (NRS) 433B to provide additional provisions related to children. This mandated that any county, whose population is 100,000 or more, establish a Mental Health Consortia. Nevada's vast geographic area required that one be created in Washoe County (Reno/Tahoe), Clark County (Las Vegas and area), and Rural Nevada (15 counties in rural/frontier Nevada). The consortium is mandated to include partners from the local, county and regional level including school districts chamber of commerce and business community, state agencies, juvenile probation, mental health care, foster care provider, a parent or guardian of a child with emotional disturbance, substance abuse agencies, advocates and provider organizations. DCFS serves as Nevada's Mental Health System of Care (SOC) expert and manages Nevada's Children's Mental Health System of Care Subcommittee as part of the Governor's Wellness and Behavioral Health Council. As evidenced by the letters of Commitment (attachments), Nevada is committed to statewide implementation to create sustainable infrastructure and services as part of the Children's Mental Health Initiative (CHMI). Nevada?s focus on SOC Expansion and sustainability is to improve mental health outcomes for children and youth (birth to 21 years of age) with a serious emotional disturbances (SED) and their families.

The FPST Circles of Care (COC) will provide the FPST community as well as the communities of the Lovelock Paiute Tribe and the Yomba Shoshone Tribe with tools and resources to plan and design a holistic, community-based, coordinated system of care approach to support mental health and wellness for children, youth, and young adults from birth through age 25 and their families. The COC project will focus on the need to reduce the gap between the need for mental health services and the availability and coordination of mental health, substance use, and co- occurring disorders. The project will promote and facilitate youth, families, community members and tribal leaders to be involved, participate and have a voice in the planning and development of a system of care model. COC will also focus on resources to reducing the impact of substance abuse and mental illness on American communities and address the behavioral health impacts of trauma and provide opportunities for the Fallon, Lovelock and Yomba tribal communities to support youth and young adults as they transition to adulthood by facilitating collaboration between child and adult serving agencies. The COC project will also participate in the development of a Tribal Action Plan, promote tribal program collaborations and cross-agency collaborations, and develop policies, procedures, and other infrastructures that will result in system-wide improvements and support implementation of the system of care model such as, standards of care for child/youth mental health services and supports. Trainings include a Gathering of Native Americans (GONA) will serve as a ?kick-start? for community participation, in addition to coordinating Systems of Care trainings for community members, youth and families and for workforce development. Additional community and workforce development trainings will focus on increasing awareness of child/youth mental health and wellness issues, the need for a coordinated approach to services, and promote increased access to mental health and wellness supports and services through a system of care approach.

Nevada P.E.P. will enhance state capacity to meet the needs of children and adolescents with serious emotional disturbances and their families by providing mechanisms for families to participate in the planning and development of local mental health services. The specific goals of the project are to: (1) Strengthen the knowledge and capacity of families with children who have mental health challenges to act as change agents to enhance systems, improve outcomes, and ensure family-driven mental health care; and (2) Build self-sufficient, empowered family networks in Nevada that effectively participate in activities to improve community-based children's mental health services and reduce disparities in access, service use, and outcomes among racial and minority populations served.

The Nevada Department of Education has developed a comprehensive approach to address the diminished capacity of youth mental health prevention and intervention activities in three of Nevada's frontier counties. Nevada's vision is for all schools to be safe and respectful, and all students to have strong social, emotional and mental health. More importantly for this project, to ensure there is seamless access to mental health support and service when needed or requested. The three local education agencies targeted for this initiative include: Pershing County School District; Lander County School District; and Humboldt County School District. This project aims to: 1) To provide a safe and respectful learning environment for all of our students through increasing mental health literacy of adults who interact with school-aged youth; 2) To promote the behavioral and mental health of students through school-based prevention and early identification efforts increasing the awareness of mental health issues among school-aged youth; and 3) To build awareness, connection and infrastructure across local and state entities that increase capacity to provide access to mental health support.

The Pyramid Lake Paiute Tribe’s Native Connections project will focus on the provision of behavioral health services for students throughout their school day as well as building resiliency using traditional cultural practices and coping skills through evidence based programs. The cultural practices will include quillwork, drum making, art therapy language classes and traditional storytelling. Our population will be those youth who attend middle and high school on the reservation as well as those students who ride busses to attend school in Reno and Fernley. The students who ride the busses are often away from their communities for ten to twelve hours each day. The access to mental health services is provided outside of the hours they are available in their community. By providing these services to the students at their schools, we expect to add at least five hundred (500) mental health visits each school year to this population which has been unserved. The goal of increasing awareness for tribal leadership in suicide, substance abuse and mental health issues will be accomplished by providing Safetalk to all of the new council members after all elections. We will provide quarterly updates through attendance at Tribal Council meetings regarding our prevention efforts in the community and the schools. To increase awareness through outreach at community events about suicide prevention we will be providing a monthly program newsletter, a Gathering of Native Americans (GONA) in the fall and spring for all students, participation in sporting events and coaching teams where the student athletes will be learning coping skills and relationship skills through frequent interaction with prevention staff who also are coaches for the local middle and high school basketball teams. To increase the number of behavioral health visits to middle and high school aged students we will provide a Marriage and Family Therapist at the schools where our Tribe has students enrolled. This will allow students to have access to a mental health professional throughout their school day thereby increasing the availability of mental health care and reducing substance use and suicide risk. During the past school year, we had a therapist available for two school days a week. This therapist provided care at the elementary school and the high school for one day each. Our behavioral health visits saw an increase of over 500 individual visits from the prior year. The population we will be serving will be the 600+ youth up to the age of twenty four years old that reside on or near the reservation. Pyramid Lake students who begin their Senior year on track to graduate are graduating at a rate of 50%. It is our plan to increase graduation rates by offering the services at school for those youth who drop out when substance use and suicide issues arise in their lives.

The Shoshone-Paiute Tribes propose a comprehensive five-year Native Connections Project to identify specifically the gaps in service, needs, resources and protocols as they relate to suicide prevention, mental health, behavioral health, alcohol and drug services and community outreach / education. The project will address the profound need the Shoshone-Paiute Tribes have for the delivery of coordinated services and continuity across the service spectrum.

Nevada Benefit to Homeless Individuals

Currently an Assisted Outpatient Treatment program does not exist in Northern Nevada; as a result, this proposal includes requests for infrastructure (not to exceed 60% of the requested budget). Based upon the proposed Assertive Community Team (ACT) structure, the total number of clients able to be served will be 85. The Case Managers will carry caseloads of 15 clients each. Their role is to engage the clients in service, motivate them to engage in treatment, attend court ordered and non-court ordered activities, monitor their mental status and ability to meet their activities of daily living, and help them schedule and organize their lives to successfully graduate from the AOT program. The goal of successful graduation from the AOT Program is that the graduate will have sufficient insight into his/her emotional states and behaviors that he/she either can manage them sufficiently to recognize early signs of decompensation and seek appropriate help, or accept feedback from a trusted person (family member, friend or mental health professional) to seek additional help and avoid hospitalization or incarceration. In addition to the services provided by the program staff, AOT clients will have full access to all appropriate services provided by NNAMHS, including an array of mental health and co-occurring groups, a Medicaid approved Day Treatment Program run by a community partner, Intensive Outpatient Programs offered by community partners, psychoeducational groups focused on better living, and occasional outings and celebrations sponsored by NNAMHS and the Nevada Alliance for the Mentally Ill (NAMI).

CCBHC PROJECT EXPANSION PROJECT ABSTRACT Vitality Unlimited, with one successful CCBHC celebrating our first anniversary, is seeking to expand our services by opening two CCBHCs in Carson City/County, Nevada and Dayton, Nevada with the hope of increasing our service base in rural Nevada by 1,000 new consumers. Carson City/County and Dayton, Nevada have a combined population of approximately 63,000 with a severe lack of services for the Serious Mental Illness (SMI), Serious Emotional Disturbance (SED), Substance Use Disorder (SUD) and Co-Occurring Disorders (COD). The Center for Mental Health Services has ranked Nevada as the worst among the 15 western states for mental illness prevalence. The study projected that 23.7% of Nevada residents will have a diagnosable mental disorder at some point in their lifetime. According to the Suicide Prevention Resource Center Nevada has the 4th highest rate in the nation and suicide is the 2nd leading cause of death for Nevadans ages 15 – 24. More Nevadans die from suicide than from homicide, HIV-Aids or car crashes. Nevada adults over the age of 65 rank highest in the nation for suicide. Suicide behavior is known to correlate with certain psychiatric disorders; over the last could of decades, Nevada has ranked at the top of the nation for per capita suicides. The Behavioral Health Barometer for Nevada shows that 14.5% of all individual 12-20 reported binge alcohol use within the month prior to being surveyed and 61.6% of all adolescents aged 12 – 17 perceived no great risk from having five or more drinks once or twice a week. These two new CCBHC’s will strengthen both Vitality’s and the State of Nevada’s behavioral health services, improve capacity, help improve the alignment between mental health and substance abuse disorder systems and increase proficiency in the use of evidence-based practices while integrating both behavioral and physical health care for our consumers. Our new locations will provide all nine core services without the use of DCOs. Vitality Unlimited opened our first state-of-the-art behavioral health clinic, a “practice without walls” on July 1, 2017. On the anniversary of our first year of service to Elko, Nevada, a town of approximately 20,450 residents we had provided over 12,000 units of service to over 1,100 consumers. Over 23% of our consumers are below the age of 17 with the youngest consumer being 3 years old. This clinic is one of two rural frontier Certified Community Behavioral Health Clinics (CCBHC) in the United States. Vitality Unlimited, a 501(c)3 non-profit corporation was founded in 1971. Long ago Vitality Unlimited began to weave into the threads of our culture an integrated network of co-occurring treatment services with clinical and non-clinical modalities, designed so that an individual’s changing needs were met as the individual moves through the treatment and recovery process. Vitality Unlimited recognizes that success must be earned through innovation, hard work, responsiveness to client and employee needs, and integrity in all business practices.