NY Discretionary Funding Fiscal Year 2020

The proposed project, entitled the BestSelf Enhanced Response for Suicide Prevention Project will serve individuals aged 25 and up who may be at-risk of suicidal ideation and behavior as well as victims of domestic violence in Erie County. BestSelf Behavioral Health, Inc. will enhance services and support for individuals at-risk of suicide ideation and behavior as well as victims of domestic violence. Both of the target populations may be at increased risk as a result of the COVID-19 pandemic. The proposed project will provide enhanced care coordination, linkage, and follow-up including safety planning. The project’s goals and objectives are as follows: Goal 1: Enhance support and services for individuals at an increased risk of suicidal ideation and behavior in Erie County. Objective 1a: By October 29, 2021, 400 unique clients will receive rapid follow-up care transition, linkage, and support after discharge from an inpatient setting Objective 1b: By October 29, 2021, 400 clients enrolled in rapid follow-up will be screened and assessed using the C-SSRS Objective 1c: By October 29, 2021, 40% of individuals enrolled in rapid follow-up will be referred to Dialectical Behavior Services (DBT) at BestSelf Objective 1d: By October 29, 2021, 10% of individuals enrolled in rapid follow-up will be referred to Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP) at BestSelf Goal 2: Provide group support for individuals who have survived a suicide attempt. Objective 2a: By October 29, 2021, 30 individuals who have survived a suicide attempt will participate in a support group for survivors based on the Didi Hirsch Survivors of Suicide Attempts Support Group model Goal 3: Provide suicide prevention training to community and clinical service providers and systems serving adults at risk. Objective 3a: By October 29, 2021, 200 community members including those serving adults at risk will receive Question, Persuade, and Refer Training (QPR) Objective 3b: By October 29, 2021, 200 community members including those serving adults at risk will receive Mental Health First Aid Training Objective 3c: By October 29, 2021, 400 community members including those serving adults at risk will receive instructions on how to access the myStrength online platform Goal 4: Provide enhanced case management and coordination services for victims of domestic violence and their dependents Objective 4a: By October 29, 2021, 200 victims of domestic violence will receive comprehensive care management and support including linkage to existing services in Erie County

Name: Empower Life on Long Island--Emergency Suicide Prevention Initiative. In a two-county area of NY with more Covid cases than 45 U.S. states and 185 nations, this project will expand access to suicide prevention resources in Nassau and Suffolk Counties to serve two adult populations. These are: (1) those who—even before Covid-19—were highly vulnerable and at high risk for suicide because they were/are disproportionately low-income, working poor, under-employed, disabled, trauma survivors, facing housing instability and/or living in isolation from services due to stigma, mobility gaps, or other hurdles; and (2) adults not previously identified as vulnerable, but whose spiking suicide risk and onset of mental health / behavioral health distress are triggered by this COVID-19 crisis. Compared to the region’s general population, our target population disproportionately comprises Black and Latinx individuals and persons of lower income, lesser housing stability (including many Veterans), and domestic violence victims. Partnering with The Safe Center LI to assure strong safety-planning and suicide prevention resources, including for victims of domestic violence during this time of crisis, CN Guidance & Counseling Services—a Certified Community Behavioral Health Clinic with 48 years of experience—will work across gov’t and community partners to prevent suicides by using: (a) mobile resources, (b) telehealth, (c) partnerships with medical centers enabling rapid follow-up with patients in ERs/hospitals/other health settings who have attempted suicide or are in crisis, (d) care transition protocols, including for people coming out of inpatient settings, (e) training of community and clinical providers, (f) screening, assessment, and clinical treatment services, and (g) community recovery supports—together closing gaps in suicide prevention, mental health, and substance use services that otherwise leave people here often waiting weeks and months for needed services. In a coordinated way, this project will deploy at least the following 8 Evidence-Based Practices supporting suicide prevention, well suited for our target population, adults ages 25 and above: (1) Mental Health First Aid; (2) Cognitive Behavioral Therapy for Suicide Prevention; (3) Peer Support; (4) Motivational Interviewing; (5) Applied Suicide Intervention Skills Training; (6) The Stanley-Brown Safety Plan; (7) Patient Health Questionnaire 9 (for depression); and (8) the Columbia Suicide Severity Rating Scale. This project will support reaching 6,600 adults with suicide screenings over 16 months. The main goal is to assure the community’s capacity to meet exploding demand for suicide prevention during the Covid-19 crisis and its aftermath, by expanding resources and local access to a full range of suicide prevention resources—integrated across the community. The project aims to take both a highly responsive and highly proactive approach, with ongoing follow-up.

Contact Community Services, Inc., a 501(c)(3) in East Syracuse, NY is proposing the COVID-19 Emergency Response for Suicide Prevention Grants Integrated with Upstate University Hospital, St Joseph’s Hospital Health Center Comprehensive Psychiatric Emergency Program, Vera House and Oswego County Opportunities. This program will help to advance efforts to safeguard the well-being of individuals at risk of suicide, domestic violence, and substance use disorders, a risk that has been elevated due to the constraints of social distancing, quarantine orders, financial stress, collective anxiety and the trauma that the world is experiencing as a result of the COVID-19 pandemic. Our community continues to face challenges related to mental health and substance use, including high rates of emergency department visits, hospitalizations, and mortality due to opioids. Suicide and self-inflicted injury also continue to be challenges locally - Oswego County has been designated as a MH Professional Shortage Area based on the ratio of the county population to the number of MH providers. Our local emergency department visit rate due to alcohol use is 55.6% (per 10,000) adults 18 years of age and older. New York State statistics indicate that 32.3% of women and 33.5% of men experience intimate partner physical violence, intimate partner sexual violence and/or intimate partner stalking in their lifetimes. In our community, of those receiving DV services, 44% reported having a substance use issue and 60% reported a mental health diagnosis. For individuals experiencing domestic violence and sexual assault who also have a substance use disorder, isolation and feeling disconnected from community resources can be even more prevalent because historically communities have had little accessible prevention educations and services for substance abuse prevention. The project meets these objectives: • Provide for rapid follow-up of adults who have attempted suicide or experienced a suicidal crisis after discharge from emergency departments and inpatient psychiatric facilities. • Establish follow-up and care transition protocols to help ensure patient safety, • Assure provision of, suicide prevention training to community and clinical service providers and systems serving adults at risk • Enable work across systems to implement comprehensive suicide prevention • Provide suicide screening, assessment, and appropriate clinical treatment and community recovery support to include telehealth by phone and computer • Provide enhanced services for victims of domestic violence and their families. Contact will work with community partners to utilize third-party reimbursements to the extent possible, serve individuals not covered by public or commercial health insurance using SAMHSA grant funds, facilitate the health insurance application for eligible uninsured clients, and connect individuals to other systems when possible.

Liberty Resources Inc. (LRI), NCQA PCMH certified and current SAMHSA PBHCI and CCBHC grantee, proposes establishing a comprehensive crisis intervention system in a three county region in Central New York (CNY), to include Onondaga, Oswego and Madison Counties. Approximately 800 will be served in the mental health crisis intervention system of mobile crisis and crisis respite. Of those, it is anticipated that approximately 75 of those will be high risk for suicide. The CNY Region is among the neediest in comparison to the state. Onondaga County’s suicide mortality rate exceeds that of New York State (NYS) of 10 vs. 8 per 100,000. In the city of Syracuse, 15.4% of adults report experiencing poor MH for 14 or more days in the last month; higher than NYS excluding NYC (11.2%). Depression is the leading cause for ED visits in Oswego County, with 8 of the top 10 conditions for ED visits in the region being BH related. Oswego County has a suicide mortality of 17.3 per 100,000 people, far exceeding the national average, twice that of NYS and the highest in CNY. Compared to NYS, Oswego County has a higher rate of binge drinking (consuming 5+ drinks in a row) at 22.5% compared to 19.6%, and a higher rate of alcohol consumption at 23.90% compared to 15.70%. Madison County also experiences a higher rate of suicide mortality than the NYS average at 14.1 per 100,000 and a Non-Suicidal Self Injury Hospitalizations at 117.4 per 100,000 persons in Madison County compared to 65.0 in NYS; in addition 11.7% of adults report poor mental health for at least 14 days of the last month, including stress and depression. Madison County is also higher than the NYS average for binge drinking at 25%. LRI proposes to expand on the continuum of behavioral health services with a focus on interventions for rapid care for adults who have attempted suicide or experienced a suicidal crisis. LRI promotes a model for Central New York (CNY) that aligns with the SAMHSA National Guidelines for Behavioral Health Crisis Care Best Practices. LRI’s existing services and key community partnerships promote a framework for this model. The system includes a Regional Crisis Call Center, LRIs Mobile Crisis team, three Residential Crisis Respite facilities, outpatient mental health and substance use disorder (SUD/OUD) services, comprehensive care coordination and care transition planning. Regional Prevention Coalition DCOs in each county will provide extensive suicide prevention training in safeTALK, Mental Health First Aid, and ASIST Training. In addition, coalitions will provide comprehensive community prevention education. All clients will be referred to LRIs outpatient services or community based recovery supports. A population of focus will be given priority access to LRIs Help Restore Hope domestic violence hotline, advocacy and shelter dwelling facilities. Suicide focused Evidenced based practices will be employed in clinical treatment. Also, telehealth services will be utilized during the pandemic situation. IT setup for Electronic Health Records will be prioritized to ensure the appropriate data collection and analysis of outcomes can be reported.

Margaretville Hospital will partner with Delaware County, NY Department of Emergency Services. Our goal is to provide all levels of EMS training as appropriate to maintain licenses and certifications relevant to serve in an EMS agency; conduct courses that qualify graduates to serve in an EMS agency; and fund specific training to meet New York State licensing/certification requirements. Margaretville Hospital is a rural Critical Access Hospital, located in Delaware County, whose mission is to provide immediate access to high quality medical care and services to medically underserved areas in the Catskill Mountains. The Margaretville Hospital EMS Training Program will serve the geographic catchment area of Delaware County, NY, which is a HRSA-designated rural county, and parts of Greene, Sullivan and Ulster counties that are also HRSA-designated rural areas that border Delaware County and are serviced by Margaretville Hospital. The fourth largest county in the state with a population of 47,980, Delaware County’s unemployment rate exceeds New York State averages, and according to 2017 NYS Community Action report, 26.4% of youth under 18 are living in poverty in Delaware County. Delaware County is home to 16 transporting agencies dispatched by Delaware 911 and six basic life support first response agencies. Of the 16 transporting agencies, only four have paid staff, while the remaining 12 are operated by volunteers. The volunteer agencies have an average of six people certified to provide emergency medical treatment by the state. To provide 24/7 coverage, each volunteer would need to commit 28 hours a week, the equivalent of an unpaid part-time job. Our objectives are to offer Certified First Responder (CFR), Advanced Emergency Medical Technician (AEMT), and Emergency Medical Technician (EMT) instruction each year for the four years of the grant. CFR classes would train ten people each year, AEMT and EMT 15 students each for a total of 160 people. In addition, we will train six paramedics, two each year beginning in the second year of the grant. If we are able to increase the number of EMS workers in our catchment area, this will reduce the number of volunteer hours necessary for each EMS worker to perform to provide 24/7 service. With the high rates of unemployment and low levels of income in this rural area, the program will provide educational opportunities that individuals might not otherwise be able to afford and will provide some paid career prospects.

New York State (NYS) will improve accessibility of mental health and substance abuse treatment, recovery support and crisis care to racially and ethnically diverse residents of New York City (NYC) and 3 suburban counties (representing 75% of NYS COVID-19 infections) by improving the telehealth infrastructure, removing financial barriers, expanding evidence-based services, and informing healthcare workers and other New Yorkers about available services. Strengthening Mental Health and Substance Use Disorder Treatment, Recovery Support and Crisis Care to Address the Impact of the COVID-19 Pandemic on residents of NYC and Lower Hudson Valley will serve 5,000 children, adolescents, adults and families impacted by COVID-19 in NYC and the Lower Hudson Valley counties of Westchester, Rockland and Orange over the 16-month grant period. The NYS Office of Mental Health (OMH) and the Office of Addiction Support Services and Supports (OASAS) are partnering with two provider-led behavioral health (BH) Independent Practice Associations (IPAs)-Coordinated Behavioral Health Care (CBC) and Coordinated Behavioral Health Services (CBHS)--that provide a comprehensive, integrated and coordinated network of mental health (MH) and substance use disorder (SUD) services, including treatment, recovery supports and crisis-care, in the 8-county service area that is the hardest hit area in NYS and among the most impacted nationally by COVID-19. Over 100 experienced OMH-licensed and OASAS certified agencies are in the two IPA networks and will participate in this project. Proposed strategies / intervention include healthcare workers and people without serious BH conditions in brief crisis counseling and treatment services as needed using easily accessed telehealth services and by removing any financial barriers; (2) Facilitating a person-centered continuum for people with serious mental health conditions and SUD through telehealth and in-person services if necessary in order to promote and support recovery while managing BH crisis in the community; (3) Improving transitions of care for people with serious BH conditions to shorten inpatient length of stay and stabilize people with serious conditions in community settings, thereby reducing emergency department and inpatient admissions. Project Goals are to mitigate negative impacts of the COVID-19 crisis on the emotional wellbeing of New Yorkers in the most impacted NYS counties by timely addressing depression, stress, trauma, bereavement, substance abuse and other issues that undermine the ability of New Yorkers to live happy, productive lives after this crisis abates.

As we self-isolate and engage in social distancing during the COVID-19 pandemic, telehealth will continue to become more and more important in our community. The goal of funding is to provide continuous, accessible and confidential patient care to COVID-19 patients and to patients with other conditions who risk contracting the coronavirus when visiting a healthcare provider, as well as to reduce the potential virus exposure to practitioners, clinicians and other essential health care staff. The proposed implementation of a comprehensive Telehealth Program will be a critical tool in addressing this national emergency. Outcomes: The SNHS's Behavioral Health Services will have the capacity to provide necessary telehealth services to patients with serious mental illness and/or substance use disorder during the COVID-19 pandemic and during possible future emergencies. Objective 1: By June 30, 2020 the SNHS's Information Technology (IT) Department will have conducted necessary procurement and purchasing processes to successfully purchase telecommunications, broadband connectivity and devices necessary for providing telehealth services. Objective 2: By July 31, 2020 the Director of the Seneca Nation's Behavioral Health Services, in partnership with the SNHS's Informational Technology Department and Seneca Health leadership, will update, revise and develop any necessary policies and procedures to implement telehealth services. Objective 3: By August 31, 2020 the Director of the Seneca Nation's Behavioral Health Unit, in partnership with Seneca Health IT and contractual software provider, will have developed and implemented training for patients, practitioners, clinicians and other essential health care workers on how to use new telehealth devices and services. Objective 4: By September 30, 2020 the Seneca Health System will be providing telehealth services to the target population.

Touro College of Osteopathic Medicine’s Expansion of Osteopathic Medical Education and Curriculum on Substance Use Disorder (EOMEC) is designed to improve best practices and education of medical students (potential primary care physicians) on identifying patients with Substance Use Disorder (SUD), increasing knowledge on Medication-Assisted Treatment, and reducing stigma among SUD patients in the underrepresented minorities and underserved communities. As a result of the epidemic of substance use disorder (SUD) facing our country and specifically our communities in New York State, EOMEC is tailored to provide evidence-based medical knowledge and tools necessary to improve best practices to manage substance abuse behaviors, facilitate positive behavioral changes, and provide appropriate treatments to vulnerable and at risk population in our communities, Harlem and Middletown in New York and Orange Counties respectively. With the growing rate of SUD among our communities, and inadequate number of well-trained and certified physicians on treatment of SUD in the healthcare system, earlier training and introduction of these potential physicians to Medication-Assisted Treatment (MAT) and best practices in managing SUD via EOMEC will increase the number of trained and certified physicians that can identify and increase awareness on SUD cases, address the needs of people at risk, and reduce stigma from SUD in the community. EOMEC will foster the preparation of these future physicians to function as traditionally trained primary care providers who are able to provide evidence-based medical care in terms of MAT to patients in various primary care specialties. EOMEC potentially is projected to produce meaningful results that influence physician clinical behaviors and promote best practices that will lead to better and improved evidence-based practice. All EOMEC training participants will be evaluated at the completion of both the didactic and clinical training module as well post-graduation.

Behavioral Health Services North (BHSN) offers comprehensive mental health (MH) and substance use disorder (SUD) treatment services in northeastern New York (NY). We will expand regional availability of services, while expanding infrastructure to control cost as we transition to value-based payments (VBP). We will expand SUD services, including medication-assisted treatment, and focus on specific programs for key populations we serve-veterans, tribes, and older adults. BHSN currently provides MH, SUD, and social services to more than 5,000 annual clients of all ages is northeastern NY with 20 licensed outpatient and residential programs in 37 facilities located in the largest population hub (Plattsburgh) north of NY's Capital District, bordered by highly rural areas abutting Canada in Clinton, Franklin, and Essex counties. This project will address unmet need for MH and SUD services within these three counties for children, adolescents, adults and older adults. Our project focuses on the hiring of direct care staff and care coordinators, training that supports our targeted programs for veterans, tribes, older adults, and individuals affected by domestic violence, and measurement enhancements to our EHR. Because of our emphasis on treating patients across their lifespan, we have an ideal opportunity to change population health status and bend the cost curve. We will enhance care coordination and direct care capacity; expand our data collection, measurement, and reporting capabilities; promote greater mobility for community-based staff; and advance interoperability. With these additional capabilities, we will make sure our clients receive the most appropriate care at the right time and setting, which supports our transition to VBP and long-term financial sustainability. We expect to achieve specific, measurable change in health status indicators such as tobacco use, BMI, screening rates, follow-up on hospitalization or crisis care, and reduced hospitalization rates. We will increase unduplicated clients by 10% annually and retaining 60% of those clients year-over-year for a total of 1,053 incremental clients over the 2-year project. Our long-term financial sustainability strategy emphasizes moving from volume to value by collaborating with other organizations on shared goals for improving health status across our community. We will collaborate to improve care and lower cost. We will continue to develop innovative population health improvement strategies supported by VBP. We are a leader in the emerging VBP market in northeastern NY, currently co-founding the Northwinds Integrated Health Network IPA, where we are on track to complete our first VBP contract early this year, and participating in the North Country Innovation Pilot. We will continue to collaborate with 13 MH and SUD providers across the 7 rural counties in northeastern NY through Northwinds and other arrangements. We will work with St. Joseph's Addiction Treatment and Recovery Center for medical detox. We will align program goals with Citizen Advocates, the only other CCBHC in our region; we currently collaborate, share promising practices, and jointly pursue funding for transformative programs that rationalize use of scarce resources to provide local care.

BestSelf Behavioral Health is requesting funding in the amount of $2,000,000 per year for 2 years to sustain and expand its current New York State Certified Community Behavioral Health Clinic (CCBHC) and the initial SAMHSA CCBHC Expansion Grant Project. Funding will sustain services currently provided through the initial expansion grant, expand capacity of the CCBHC Assertive Community Treatment (ACT) Team, and support implementation of an additional clubhouse located in southern Erie County. The population of focus for the proposed project includes individuals with serious mental illness (SMI) or a substance use disorder (SUD); children and adolescents with serious emotional disturbance (SED); and individuals with co-occurring disorders (COD) residing in Erie County, New York. By project end, BestSelf 2020 CCBHC Services Expansion will provide direct services to 1,525 clients (763 annually) who will receive these additional services, reduce all-cause hospitalizations, and improve medication adherence rates. Goals and objectives for the proposed project include providing access to: the social support activities provided through two clubhouse locations to 650 clients annually; CCBHC ACT services to a 75 client case load; and comprehensive services for 75 transition age youth who may be at risk of suicide, homelessness and serious substance use, annually. These CCBHC expansion services will supplement current activities and continue to enable BestSelf to provide comprehensive community-based mental health and substance use disorder services in an approach that emphasizes recovery, wellness, trauma-informed care, and physical-behavioral health integration.