OK Discretionary Funding Fiscal Year 2018

Oklahoma, a state with the second-highest American Indian (AI) population, has a suicide rate that is one of the highest in the nation. Despite this, there remain significant gaps in prevention, intervention and postvention treatment of AI youth ages 10-24.

The Central Oklahoma American Indian Health Council, Inc, dba Oklahoma City Indian Clinic (OKCIC) proposes this five-year Native Connections project. The first year of the project will entail convening community stakeholders throughout central Oklahoma to conduct a service delivery systems analysis; a community needs assessment; a community readiness assessment; and a community resource/asset map that addresses both suicide prevention and substance abuse and misuse prevention. This work will culminate in a plan the uses the SAMHSA Strategic Prevention Framework planning process to guide the selection, implementation and evaluation of effective, culturally appropriate and sustainable prevention activities that encompass Tier 1, Tier 2 and Tier 3 of this project.

In subsequent years, OKCIC will use the plan developed in Year 1 to provide services to AI youth in central Oklahoma. Evaluation will be a key part of this project, which will be overseen by the OKCIC Director of Quality Improvement.

The OKCIC Behavioral Health Department will conduct this project. Staff are well trained on evidence-based practices as well as experienced in culturally appropriate treatment. Staff members in this department are very active in community efforts to create positive impacts. Staff will leverage these existing relationships to recruit a wide range of community members, including youth and their families, to the planning activities.

Throughout the project, OKCIC will continue to screen all patients ages 11+ for depression, domestic violence, suicide ideation and other risk factors. Patients who are considered at-risk will continue to receive immediate care and/or referrals.

The Cherokee Nation seeks to fashion a wide-ranging and integrated suicide/substance abuse prevention system to detect prevent, and provide early intervention services to American Indian youth who reside within the rural 14-county area of northeastern Oklahoma served by the tribe. Further, the Cherokee Nation shall enlist area communities, area child-serving agencies, Cherokee Nation health facilities, and schools in the planning, assessment, implementation, and evaluation phases.

Cherokee Nation Behavioral Health Prevention Department's (CNBHPD) Native Connection project is a two-tiered response to the chronic problem of suicide in our communities. This project will focus on universal strategies with a high emphasis on traditional Cherokee traditions and customs.

Through eleven Community Action Groups, this project will increase the capacity of Cherokee Nation systems to respond to risk and protective factors associated with suicide risk. Tier one activities include Cherokee Cultural activities that engage tribal members across generations in order to strengthen familial and tribal bonds. Tier two activities integrate targeted strategies into the cultural activities such as screening for high-risk youth. A key component is to provide mental health training throughout the Tribal Jurisdictional Service Area.

Consistent with SAMHSA's Strategic Initiative #1, Cherokee Nation will focus on primary prevention. Although any given activity will be specific to local community context, all activities in general must build emotional health, reduce suicidal behavior through prevention approaches, prevent the abuse of prescription drugs by young people, prevent or delay the onset of alcohol use by minors, and/or mitigate the impact of suicide, substance use, trauma and mental illness. All strategies employed will be part of a comprehensive Strategic Prevention Framework (SPF)-based approach and based upon relevant scientific and evidence based practices.

Cherokee Nation -- Honoring Life Zero Suicide The proposed project is a partnership between Cherokee Nation Behavioral Health (CNBH) and suicide prevention experts from Johns Hopkins University to implement evidence based services to prevent suicide attempts and deaths. The project will take place in northeastern Oklahoma, which like other rural communities is high risk for multiple health disparities. The prevalence of suicide among Native Americans (NA) in Oklahoma was 10.5/100,000 between 2000 and 2014. However, these estimates provide an overall picture of the problem, determining the true prevalence of suicide among NAs is more complicated due to inconsistency of data and racial misclassification. Further, current screening procedures by Cherokee Nation Health System (CNHS) is likely leading to a vast underestimate of the actual suicide burden. The proposed project is being submitted to effectively, efficiently, and sustainably implement all seven elements of the Zero Suicide model to prevent suicide attempts and deaths. CN will implement the Zero Suicide model in all sites that comprise the Cherokee Nation Health System. The goals of the proposed project are to raise awareness, implement universal screening, track over time patients who screen positive for suicidality, and establish a high-quality, effective model of care for individuals at risk for suicide. These goals will be achieved by implementing evidence-based programs (EBPs) with strong research support and collecting a wealth of data that will increase the breadth, depth, and richness of the data to be leverage to create an incessantly improving learning healthcare system to cultivate a culture of life within CNHS. The CNBH-JHU partnership has chosen to combine the use of the three separate EPBs: 1) universal screening using the Columbia-Suicide Severity Rating Scale, 2) the White Mountain Apache Suicide Surveillance System, and the Collaborative Assessment for Managing Suicidality (CAMS). This multi-tiered and multi-faceted approach is absolutely critical to eliminating suicides from the CNHS. Further, the selection of a single EBP would not provide the breadth and depth required to fully integrate all seven elements of the Zero Suicide Model into the CNHS. The proposed project represents a passion for eradicating suicide and the selection of multiple EPBs is a testament of the CNBH-JHU partnership striving for this goal in full measure.

Project Name: Project LAUNCH Program of the Chickasaw Nation Population Served: American Indian Non-reservation Children from birth to age eight. The purpose of this Substance Abuse and Mental Health Services (SAMHSA) Indigenous – Project LAUNCH cooperative agreement is to promote the wellness of young children from birth to 8 years within American Indian (AI) tribes by addressing the physical, social, emotional, cognitive and behavioral aspects of their development. Its goal is for children to be thriving in safe, supportive environments and entering school ready to learn and succeed. The Chickasaw Nation offers a vast variety of services aimed at enhancing the overall quality of life for the Chickasaw people, as well as the American Indian population living within the Chickasaw Nation’s boundaries. Services and programs range from early childhood education to elder care. However, many programs and services are not linked throughout the Chickasaw Nation. The Chickasaw Nation plans to utilize the resources provided through Project LAUNCH to improve collaborations between departments such as Education, Family Services and Health, each of which plays a unique role in improving the lives of young American Indian children living within the pilot communities and throughout the Chickasaw Nation. The structure, key personnel and resources provided by the Project LAUNCH will improve communication, collaboration and referral systems across departments and throughout the pilot communities of Carter, Johnston and Pontotoc County, Oklahoma. The project will also improve existing programs and increase the capacity of the Chickasaw Nation to identify, prevent and address behavioral health or developmental issues for American Indian children from birth to 8 years of age living in extremely rural communities. The Chickasaw Nation estimates that only 45 percent of the AI child population under the age of 9 years living within the pilot communities (1,125 individuals), are currently being served. The goal for the Chickasaw Nation Project LAUNCH is to serve 75 percent of this population by the end of year five, with an increase of six percent each year thereafter. The target population is rural non-reservation American Indian children from birth to age 8 living within Carter, Johnston and Pontotoc County, Oklahoma. Goal 1: To provide safe and supportive environments that allow American Indian children from birth to age eight, who reside within the area of Oklahoma served by the Chickasaw Nation, to thrive, enter school ready to learn and with the ability to succeed. Goal 2: To improve the family support system by increasing parenting skills and knowledge, promote healthy child growth and development and enhance development and positive parent-child relationships by using existing Chickasaw Nation resources, activities and partnerships.

Choctaw Nation of Oklahoma proposes to implement Tomorrow's Hope, a project that will better integrate the following services: medical, behavioral health, prevention, substance abuse treatment, Jones Academy (residential educational facility), domestic violence, Eastern Oklahoma State College, and law enforcement in an effort to firmly establish new linkages and strengthen a system wide response to suicide prevention/intervention. Tomorrow's Hope proposes to annually: a) train 1,100 youth, service providers and community members in 40 QPR (Question, Persuade, Refer) trainings; b) train 100 medical providers in Emergency Department Means Restriction Education (NREPP Registry, 2014); c) train eighty Choctaw Nation Youth Advisory Board members and Jones Academy students (80) in Coping and Support Training (CAST, age 13 to 24); and d) refer/engage 240 youth and 120 family members per year in 3 to 4 month long outpatient treatment for substance use, mental health or both; offer law enforcement officers and campus police training opportunities related to suicide intervention and QPR. This means that this project will impact, minimally, 8,000 youth, health providers, college students, Jones Academy students, law enforcement and family members during its five-year duration and hopefully, throughout their lives. Services proposed will be based out of the three counties (McCurtain, Pittsburg, and Latimer) that evidence the highest suicide rates. However, because Tomorrow's Hope will build a system wide approach, all 10 1/2 counties served by the Choctaw will benefit as all counties utilize clinic and hospital services. Tomorrow's Hope, will enhance already existing linkages, build new ones, strengthen the net of protection through education, introduce and expand evidence based interventions, utilize EHR to establish a "Community Alert" (a function within the EHR system to notify both medical and behavioral health to a patient's risk for suicide), and reduce access to means.

The Choctaw Nation of Oklahoma (CNO) is committed to preventing and reducing suicide behavior, substance abuse, and the impact of trauma by promoting improved mental health among the American Indian/Alaska Native (AI/AN) youth residing in the boundaries of the CNO. We propose to accomplish this by launching Project Embrace, an initiative aimed at developing strategies to: 1) reduce the impact of mental and substance use disorders; 2) establish a fast and culturally based response to any suicide intent; and 3) increase the efficacy of the surveillance of suicide, suicide attempts, and mental health challenges in an effort to better support and serve AI/AN youth and young adults up through the age of 24. Four counties within the CNO's service area of 10 1/2 counties will be targeted for this project. These four counties fall within the top 10% of highest suicide rates in the state of Oklahoma. Our vision for healthier youth will be implemented using community driven and culturally based strategies: a) that focus on all young people through age 24, regardless of risk of suicide and substance use and misuse; b) that focus on subgroups of young people through age 24 for whom suicide or substance use and misuse may be much higher than average; and c) that are designed for young people through age 24 who are at high risk for suicide or substance use and misuse, who have already attempted suicide, and/or who are using or misusing substances
Project Embrace will be grounded in the concepts of Community Readiness and it is anticipated that we will complete a Community Readiness Assessment, an assessment of our service delivery system, train Emergency Department and clinic staff in QPR for nurses and other providers, utilize QPR, ASIST and other evidence based curricula as identified by the community in the Strategic Action Plan. It is expected that we will reach approximately 12,000 youth in the four county area over the course of the five year grant.

ABSTRACT Project Name: Defending the Future Population Served: Rural Non-Reservation American Indian College Students Methods: Networking, gatekeeper training, seminars, QPR, and YMHFA Number Served: 375 annually and 1,125 over the project period The College of the Muscogee Nation seeks to establish an integrated public health approach to suicide prevention, substance abuse prevention, and mental health promotion to detect, prevent, and provide early intervention services to rural non-reservation American Indian youth and emerging adults who reside within the 11-county area of northeastern Oklahoma served by the College of the Muscogee Nation. This system shall develop infrastructure, expand and enhance current programs, and provide the foundation for creating a prevention-prepared campus, promote wellness, encourage student help-seeking behaviors, and increase collaborative partnerships for delivering and sustaining effective, efficient, and culturally appropriate services. The College of the Muscogee Nation?s (CMN) Defending the Future project shall define the need for services, the gaps between needed and available services, barriers to care, and other problems related to the need to implement suicide prevention and early intervention activities for American Indian students (youth and emerging adults) at risk of or currently experiencing issues that may lead to suicide. The project shall increase the number of individuals and gatekeepers trained to identify, assess, and manage students at risk for suicide within the campus service area. The result will increase early identification, improve the continuity of care, increase utilization of the National Suicide Prevention Lifeline, and further implement the National Suicide Prevention Strategy. Goal 1: To increase the infrastructure, capacity, effectiveness, and efficiency of suicide prevention services for American Indian students who attend the CMN. Goal 2: To reduce the prevalence of suicide and suicidal behaviors among the at risk student population at CMN. Goal 3: To promote systems level change at the tribal college to embrace suicide prevention as a core strategy.

The "CREOKS CCBHC Expansion Project (C-CEP): Mobile Crisis, Health Home Teams, and Primary Care for Rural Oklahoma, Prioritizing Veterans and Welfare/Juvenile Justice Involved Children" addresses unmet psychiatric, substance use, and medical needs for seven rural counties with an area population over 310,000 that have suicide rates nearly twice the national average, drug overdose deaths 33% higher, and death due to coronary artery disease three times higher. These conditions appear disparate but effective interventions for all three lie in detection and early intervention through assertive outreach as well as the management of risk factors and the promotion of supports that lead to improved functioning and quality of life. To this end, C-CEP has adopted the following goals: (1) increase access to services for adults with serious mental illness (SMI), adults with substance use disorders (SUD), including opioid use disorders; children and adolescents with serious emotional disturbance (SED); individuals with co-occurring disorders (COD); and, prioritizing veterans and welfare/juvenile justice involved children by assertive engagement, augmenting needed services, and increasing enrollment; (2) reducing emergency department, hospital utilization, and suicide through improving depression screening and treatment as well as post hospital/crisis center follow-up care; (3) improving the functioning of families with children at risk of out of home placement, school suspension, and law enforcement involvement through wraparound services; (4) improve preventive care with screening and early intervention; and (5) improve chronic disease management through effective risk factor control. C-CEP employs mobile crisis teams to engage people in the community who need services and the project works to reduce the wait times between first contact and treatment. Services have been augmented to provide for Health Home teams. Theses interdisciplinary teams provide wraparound supports that can address psychiatric, substance use, and medical needs at the same time. Due to vulnerabilities and an acute lack of services in our communities, veterans and welfare/juvenile justice involved children are prioritized for Health Home team care. There is an emphasis on detection and early intervention. C-CEP conducts a variety of screens to identify substance use, depression, suicidal ideation, metabolic syndrome, and other risk factors for treatment. Primary care screening and monitoring of key health indicators and health risk are offered to all persons and medications are made available to treat psychiatric, substance use, and coronary artery disease. Outcomes are measured in numbers of new adults and children served, number of persons receiving mobile crisis services, numbers of veterans and welfare/juvenile justice involved children receiving Health Home services, screening and documented follow ups for risk factors, reduction in PHQ-9 depression scores, reduction in school days missed, reduction in law enforcement contact, reduction in self-harm, controlling HbA1c < 8%, controlling blood pressure < 140/90, and maintaining LDL-C < 100 mg/dL. C-CEP will serve 5,000 adults and children in year one and 10,000 over the course of the two-year project.

The Regional Mental Health Awareness Training (RMHAT) Grant will serve the entire populations of Pontotoc, Johnston, & Murray counties by providing mental health awareness training, promoting resources & supports, establishing referral systems, & further developing collaborative partnerships to respond to mental health issues. This tri-county area covers 1,789 square miles with a population breakdown of 38,224 in Pontotoc County, 13,853 in Murray County, & 11,060 in Johnston County. The RMHAT grant aims to train a minimum of 750 adults within this region in Youth & Adult Mental Health First Aid (MHFA), which combined with the 750 existing First Aiders in Pontotoc County, will result in a ratio of 1 First Aider for every 42 individuals (approximately 1 First Aider per square mile). Special populations of focus will include individuals who regularly interact with or serve: veterans and their families, individuals with disabilities, Native Americans, and at risk youth, as well as law enforcement. Goal 1: Increase awareness & capacity of adults in Pontotoc, Johnston & Murray Counties to respond to & interact with individuals experiencing mental health or behavioral health issues. Objective 1A: Train 4 additional MHFA Instructors in Murray/Johnston Counties by 9/30/2021. Objective 1B: Maintain 9 previous & 4 additional MHFA Instructors through 9/30/2021. Objective 1C: Train 750 MH First Aiders in region by 9/30/2021 at the rate of 250 per year. (165 more individuals in Pontotoc County—55 per year, 255 individuals in Johnston County—85 per year, & 330 individuals in Murray County—110 per year). Objective 1D: Increase First Aider ability to identify common mental health symptoms by 20% by 9/30/2021 as measured by MHFA training pre/post surveys. Goal 2: Provide outreach & engagement with organizations & citizens to promote positive behavioral health. Objective 2A: Provide at least two educational engagement opportunities for agencies to increase knowledge of mental health issues & resources by the end of each grant year (9/30/19, 2020, 2021). Objective 2B: Provide at least two educational engagement opportunities for general citizens to gain a better understanding of mental/behavioral health issues & resources by the end of each grant year (9/30/19, 2020, 2021). Goal 3: Increase knowledge & access to mental health or behavioral health services for individuals & families. Objective 3A: Provide 100% of MH First Aiders trained with resource & referral guide for the region (9/30/2021). Objective 3B: Track referrals conducted by MH First Aiders by collecting monthly referral surveys from 50% of MH First Aiders by the 5th of the following month (11/5/18, 12/5/18, etc). Goal 4: Increase community partnerships & collaboration of mental health programs. Objective 4A: Develop leadership committee of at least 10 individual &/or agency partners from mental health & related sectors by 12/30/2018. Objective 4B: Host quarterly meetings of committee to address needs, gaps, & progress toward goals by 12/31, 3/31, 6/30, & 9/30 yearly. Objective 4C: Collaborate with mental health partners to conduct yearly update of needs assessment by end of each grant year (9/30/19, 2020, 2021).

The purpose of the East Central University (ECU) Campus Suicide Prevention Grant Program is to facilitate a comprehensive approach to suicide prevention on the ECU campus in Ada, OK. This program will increase collaboration of campus partners in the area of suicide prevention, increase suicide prevention/intervention trainings, increase the number of materials provided on campus related to suicide prevention, decrease stigma around mental health and help seeking, and increase promotion of the National Suicide Prevention Lifeline. The program will also serve as a connection resource to better link students and families experiencing mental health or behavioral health issues to appropriate services. The entire University student population will be targeted with the proposed program. This includes approximately 4,500 students attending ECU. Within this population, a number of vulnerable groups will be served including veterans, Native Americans, and LGBT individuals. ECU is a public 4-year regional university and is located within the City of Ada, which has a population of approximately 17,303 and is the county seat of Pontotoc County with 38,194 residents. In addition, Ada is the seat of government of the Chickasaw Nation, and as much as 13% of the population within the targeted campus is Native American. Strategies and goals to be accomplished by this program include the following. Goal 1: Increase campus infrastructure and collaboration around suicide prevention. Objective 1A: Develop a Project Leadership Team consisting of a minimum of 10 campus partners by 12/31/2017. Objective 1B: Maintain 10 Project Leadership Team members throughout grant period (9/30/2020). Objective 1C: Facilitate Project Leadership Team members on a minimum of a quarterly basis through grant period (9/30/2020). Objective 1D: Via Project Leadership Team, develop a crisis response plan and revise as needed by 3/31/2018. Goal 2: Increase availability of suicide prevention and intervention training and materials on campus. Objective 2A: Provide at least 450 students & employees gatekeeper training programs by 9/30/2020 resulting in a ratio of 1 gatekeeper for every 10 students. Objective 2B: Increase peer helping via provision of Student Support Network to at least 30 students by 9/30/2020. Objective 2C: Provide 100% of students and employees with suicide prevention materials and other information by 9/30/2020. Goal 3: Decrease student rates of suicide risk factors. Objective 3A: Decrease number of students reporting substance misuse by 5% by 9/30/2020. Objective 3B: Decrease number of students reporting feelings of sadness by 5% by 9/30/2020. Objective 3C: Decrease number of students reporting feelings of overwhelming anxiety by 5% by 9/30/2020. Objective 3D: Reduce access to means by hosting at least 1 prescription drug take back event on an annual basis (9/30/2018, 9/30/2019, 9/30/2020). Objective 3E: Reduce access to means by providing safe storage information on prescription drugs and firearms to 100% of students and employees by 9/30/2020.