NV Discretionary Funding Fiscal Year 2020

ABSTRACT Project Name: Nevada Comprehensive Crisis Stabilization Response Nevada is targeting emergency dollars to the two largest urban counties of Clark and Washoe, which represents 88.9% or 2.8 million of the states population with many proposed activities benefitting the entire state. Clark and Washoe are the two counties hit with the largest per capita impact from COVID-19. As part of Nevadas comprehensive crisis stabilization response, the focus will be on 1) establishing a regional psychological stabilization or triage center targeting SMI/SUD as well as non-SMI/SUD; 2) Expanding Mobile Crisis Teams with the telehealth abilities to support rural areas to target SED; and 3) establishing a Medical First Responder warm line that is culturally competent for direct clinical support for healthcare workers through licensed professionals. With an increased demand being placed on our health care providers due to COVID-19, an individual experiencing a mental health crisis in Nevada may be subjected to significant delay in accessing services, awaiting care in an emergency department instead of receiving services in an appropriate mental health facility. Inability to access appropriate, timely care can have serious consequences, resulting in unnecessary decompensation and decline in well-being. This scenario is even more likely for those in crisis due to many social and economic actions that have been taken as a result of COVID-19. The approach works to ensure that those in crisis receive the appropriate level of care timely. Nevadas goal is to reduce the medical emergency room visits for mental and behavioral health triage by 70% over the next year. By utilizing a three-prong approach which includes diverting transports of those suspected of having mental or behavioral health crisis by law enforcement and emergency services to the triage center, expanding the ability of mobile outreach, and providing services to Nevadas healthcare workforce, Nevada is supporting a healthy continuum of crisis services designed to stabilize and improve symptoms of distress and feature a continuum of care services including 23-hour crisis stabilization/observation beds/chairs, medical detox, and short term crisis residential services and crisis stabilization through the full continuum of mental and behavioral health services.

Population to be served: The Children's Cabinet, working alongside Washoe County School District and Quest Counseling and Consulting has selected the Youth Mental Health First Aid training to deliver parents, teachers, school staff, community members, youth service professionals, foster parents and caring citizens that work with youth ages 12-18 years old. The targeted community is located in Northern Nevada, in Washoe County. At least 100 individuals will complete this training in year One of the grant, and at least 250 individuals will complete the 8-hour training in each of Years Two and Three. Services to be provided: The overall goal of the project is to improve mental health outcomes for Washoe County, Nevada youth. Specific objectives include: 1. Increase awareness of mental health issues among youth 12-18 via the approved SAMHSA YMHFA 40 trainings over the life of the grant. 2. Conduct outreach and engagement strategies with youth 12-18 and their families to increase awareness of and promote positive mental health via social media, website and community health forums. 3. Increase the mental health literacy of school personnel and other adults who interact with youth 12-18 years old via 10 YMHFA trainings in Year One (100), 15 YMHFA trainings in Year Two (250) and 15 YMHFA trainings in Year 3 (250) for a total of 600 individuals trained over the life of the grant. 4. Increase the capacity to respond to the behavioral health issues and developmental needs of youth ages 12-18, through arming individuals who work with youth and providing the educational and referral tools needed as depicted through the SAMHSA YMHFA 40 delivered trainings over the life of the grant. Coordination with local health agency: To establish efforts to focus community resources on enhancing prevention and awareness activities aligned to the tragedy of teen suicide, a partnership has been established with Quest Counseling and Consultation. Coordination with Washoe County School District: To establish training efforts to focus on parents, teachers, school staff, community members, youth service professionals, foster parents and caring citizens that work with youth ages 12-18 years old a partnership has been established with Washoe County School District. Evaluation: A full evaluation of the project will be conducted by a third party professional and experienced evaluator to conduct all summative and formative data collection, project monitoring, quality assurance, and program reporting activities.

Nevada Project Aware 2020 Introduction: The Nevada Department of Education, working alongside its State and Community partners, will increase mental health awareness, screening, and connections to community-based mental health services within a framework of Multi-Tiered System of Supports across three Local Education Agencies (LEA): Washoe County School District, Carson City School District, and the Nevada State Public Charter Authority. Populations to be served: Washoe County School District (WCSD) is Nevada’s 2nd largest school district in a county that covers 6,300 square miles with more than 471,500 citizens; WCSD serves 64,402 majority-minority students in 117 primary and secondary schools across 19 zip codes. Carson City School District is Nevada’s 6th largest school district in a rural county that spans 157 square miles with about 55,400 citizens; Carson City serves more than 7,800 students in 13 primary and 1 secondary schools across 11 zip codes. (American Community Survey, 2019); Nevada’s State Public Charter School Authority (SPCA) sponsors 29 charter schools statewide and is the 3rd largest school district in Nevada, serving approximately 36,000 students. Goals: Tier 1 Goal: Increase awareness of mental health issues among school-aged youth. Tier 2 Goal: Provide training for school personnel and other adults who interact with school-aged youth to detect and respond to mental health issues. Tier 3 Goal: Connect school-aged youth, who may have behavioral health issues (including serious emotional disturbance (SED) or serious mental illness (SMI), and their families to needed services Objectives (not all shown): Objective 1A: By September 2021, 17 pilot schools (across the LEAs) will implement or strengthen evidence-based, culturally competent strategies so that school-aged youth develop skills that will promote resilience and promote pro-social behaviors, evidenced by pilot schools: (1) moving from favorable to most favorable in 3 out of the 5 student school climate survey constructs by 2025 and (2) year to year reduction of school discipline incidents (3) 10,642 unduplicated students will be served by enhanced tier 1 strategies across the 3 LEAs. Objective 2B: By May 2023, 17 pilot schools will implement mental health screening and training to detect early signs of mental health issues, identify strengths in school-age youth, and help accurately refer to school based tier 2 or tier 3 supports and refer to community based support for tier 3 clinical services, as evidence by: (1) screening process in place, (2) # of students screened each year (3) # of school based referrals (4) # of community based referrals. Objective 4B: Develop an infrastructure that will sustain and expand mental health and behavioral health services and supports for school-aged youth when federal funding ends by being able to bill for Medicaid for eligible services. Numbers of Unduplicated Students Served by this project Approximately 10,642 unduplicated students will be served by this grant with Tier 1 supports, 20-25% (2660) of those students may need Tier 2, and 10-15% (1,596) of those students may need Tier 3. Our goal is that by the end of the grant, the percentage of the students needing Tier 2 and 3 services will significantly decrease as well. Our theory of change is as we strengthen Tier 1 activities, need for Tier 2 and 3 will decrease.

Nevada’s Rural Region is requesting funds to enhance early jail diversion to divert adults with Serious Mental Illness (SMI) or Co-occurring Disorders (COD) away from the criminal justice system. The region is a rural jurisdiction covering Churchill, Lyon, Carson, and Douglas Counties. This rural region is home to 179,016 residents and is located East of the state’s capital. The region encompasses 8,050 square miles and is nearly the size of New Jersey State. The counties have a documented history of cross-system collaboration, as evidenced by ongoing regional meetings to implement and enhance the Sequential Intercept Model throughout the region. The region will implement an Assertive Community Treatment (ACT) team to support community members identified at early intercept points. The target population are adults with a serious mental illness (SMI) or co-occurring disorder (COD) experiencing chronic crisis who are identified through Mobile Outreach Safety Teams (MOST) and Crisis Intervention Trained (CIT) law enforcement officers in the first intercept. The region will consider veterans a priority population. The region will serve a minimum of 300 individuals through ACT early jail diversion programming. The goals of the program are: Goal 1: Enhance collaboration planning between the community-based providers, behavioral health, and law enforcement. Goal 2: Increase identification of people with mental health and co-occurring disorders at early intercept points in the criminal justice system. Goal 3: Increase front-end diversion of people with mental health and co-occurring disorders.

Touro University Nevada (TUN): Raising Resiliency Together is designed to provide TUN medical students with the knowledge and confidence to identify and overcome the stressors that contribute to substance abuse and mental health issues before they become debilitating and dangerous situations. Medical students face intense stress and experience both mental illness and suicide at a higher rate than their peers and the population as a whole. TUN will build campus capacity and infrastructure to help these students by forming a Behavioral Health Advisory Board and implementing activities including: 1) A coaching program directed primarily at students from underserved and underrepresented populations; 2) A long-term counseling model to increase access to campus counseling services; 3) A series of trainings and presentations for students, faculty, and staff; 3) Self-assessments that flag and refer students to needed services; and 4) Outreach activities that will promote awareness and action for students, faculty, and staff. The programs will reach and serve 1500 faculty, staff and students. TUN enrolls approximately 1,400 students in osteopathic medicine, physician assistant studies, nursing, occupational therapy, physical therapy, and education. The osteopathic medicine program is the largest medical school in Nevada. TUN’s student population demographics are: 53% white, 32% Asian, 6% Hispanic of any race, 4% two or more races, 3% black or African-American, 2% unknown, .5% native Hawaiian or other Pacific Islander, and .1% American Indian or Alaska native. Fifty-two percent of TUN students are female and 48% are male. Seventy-four percent of students are age 20-29, 19% are age 30-39, 5% are age 40-49, 3% are age 50-59. The average age of students is 28 years old. Veterans make up .6% of students and .3% are student dependents on VA benefits. The goals of TUN Raising Resiliency Together are to: 1) Grow and strengthen the institution’s infrastructure and network of mental-health and substance-abuse treatment resources and services; and 2) Increase the capacity of resiliency, emotional well-being, and mental health of all TUN students, including those traditionally underserved and underperforming student groups, in order to address the prevalence and severity of mental illness in medical students. The corresponding measurable objectives are to: 1) Increase the number of counseling hours available to students from 30 to 60; 2) Increase student self-awareness of alcohol, drug, and other risky behaviors; 3) Increase student knowledge and awareness of campus and community mental-health resources; 4) Serve 50 students per year (100 total) in a new coaching program to help create resiliency during years two and three; 5) Increase the frequency of campus awareness and prevention presentations to one per month by dean of students and Student Counseling Services, in addition to presentations given by the Drug and Alcohol Committee; 6) Increase student attendance at awareness and prevention trainings and presentations by 10%; and 7) Increase faculty and staff attendance at awareness and prevention trainings and presentations by 10%.

The Washoe Nation (WN) Health Clinic Healing Center's youth suicide prevention and early intervention project will improve/expand upon strategies in behavioral health programs, educational Institutions, juvenile justice systems, and other child- youth-serving organizations for ages 10-24 struggling with trauma, depression, and/or suicidal ideation living in WN's four reservation communities( Carson, Dresslerville, Stewart, and Woodfords) and surrounding areas. Services target Washoe and American Indian/ Alaskan Native youth and their family members in the community sitting. Prevention (improve response to suicide) includes informing participants, partners, professionals, and the public in effort to prevent, delay, reduce or eliminate suicide and promote wellness in the communities. It will include universal, selective and indicated prevention types. Strategies will include information dissemination (public awareness campaign), education, alternatives, early identification/referrals, capacity building, and environment (tribal codes). Quarterly community presentations, submission to the Health Centers newsletter, and community wide activities will take place in the communities. Early Intervention (screening and referral will increase our community's ability to identify and refer youth at risk for suicide in multiple departments throughout the WN including, but now limited to, education , health, juvenile probation, recreation and social services ( including Tribal Temporary Assistance for Needy Families). Gatekeeper and Crisis Intervention training for 50 community providers, partners, and public takes place eight times per year (400 total). Early Intervention (assessment and services) will naturally result after a positive screen and referral. A school-based Mental Health Therapist will provide crisis intervention , assessment and treatment (including post-suicide intervention) onsite within the school system for an estimated 30 youth per year. Continuing Care Services (including post suicide intervention) will assist youth in transition (step down) from more intensive to less intensive services as they reconnect with their community. Behavioral Intervention Specialist (intensive services for very high risk) will provide behavioral modification with youth in community, school, office and home settings for approximately 20 youth total per year. Medical Social Worker will coordinate wraparound services with community providers to include, at minimum, screening, crisis intervention, care coordination, and family support for an estimated 75 youth and their family members at community- and office-based settings. Data collection and sharing will inform community members, leaders, partners, and professionals.

The proposed State Opioid Response project aims to address the opioid and stimulant crisis in Nevada by increasing access to treatment, reducing unmet treatment need, and reducing opioid/stimulant overdose related deaths through the provision of prevention, treatment and recovery support activities for opioid use disorder and stimulant misuse. The complexity of the issues of opioid and stimulant use and addiction, both nationally and in Nevada, requires a multi-pronged approach that brings together prevention, early intervention, treatment, law enforcement, public policy, public health models, and recovery oriented systems of care. The crisis has highlighted continued opportunities for growth within state and local infrastructures that need to be brought together to develop a comprehensive, coordinated system of care. Nevadas vast geography and healthcare provider shortage contribute to a challenging environment to implement community-based strategies to combat the crisis. Stigma and lack of knowledge about available services continue to prevent individuals to seek treatment and physicians from linking and referring individuals to much needed opioid or stimulant use disorder treatment and recovery supports despite availability within treatment centers. Nevada has implemented a hybrid system of care to address the treatment needs for OUD Treatment and MAT Expansion. The following communities remain a of focus for State Opioid Response Grants (SOR) funding and includes: Pregnant and Post-partum women with OUD, and their newborns/dependents; Patients Reentering Communities from Criminal Justice, or other Rehabilitative Settings; Intravenous drug users and persons with OUD and co-morbidities, e.g. HIV/AIDS, Hepatitis C, and Tuberculosis; Veterans and Military personnel; and Aging Population with Intellectual and Developmental Disabilities. With this funding opportunity, Nevada will continue to address the unique needs of its communities and establish a long-term sustainable, coordinated, recovery-oriented system of care using the Collaborative Opioid Prescribing Model, overdose response and treatment engagement programs, overdose education and naloxone distribution, prescriber education and expansion of office based opioid treatment, recovery communities and peer supports, enhanced data collection, and information sharing between public health and law enforcement while maximizing existing resources including Medicaid reimbursement.

The Washoe Tribe of Nevada and California Healing Center Tribal Opioid Response grant will serve AI/NA people living in the Washoe Tribes four communities and surrounding service area, including Douglas County, Carson City, Alpine County, and Mono County. The goal of this project is to decrease the use and misuse of both prescription and non-prescription opioids. This project is continued from the 2018 TOR Grant awarded to the Washoe Tribe. By the end of year one we will have our multi-dimensional treatment/education/outreach program will be continued and expanded. With a fully functional Medication Assisted Treatment program, Intensive Outpatient Program, Prevention Education, and Harm Reduction. By the end of year two we will continue the above programming and begin to engage the communities in White Bison Training and Peer support activities.