OR Discretionary Funding Fiscal Year 2018

Summary: The purpose of the Integrated Prevention and Empowerment Project is to establish connectivity between existing youth prevention programs and to develop and deploy new programs where needed so that CTCLUSI Tribal youth can seamlessly move from age-appropriate program to program as they travel towards adulthood. Therefore, while the population focus is on all youth, there are distinct age brackets connected with various programmatic approaches. Project Name: Integrated Prevention and Empowerment Project Project Population: The project is designed to serve members of the Confederated Tribes of Coos, Lower Umpqua, and Sisulaw Indians ages birth to 24 years of age. Currently this population segment consists of 517 Tribal members or 43% of the Tribe's total membership. The preponderance of Tribal members served live within one of the five counties (Coos, Curry, Douglas, Lane, Lincoln) of the Tribe's primary service area all located in western Oregon. Strategies/Interventions: The Integrated Prevention and Empowerment Project is a capacity-building approach based on a number of specific phases and strategies including 1) Assessment Phase, 2) Policy and Procedure Development, 3) Protocols and Postvention Protocol Development, 4) Tribal Action Plan Development, and 5) Addressing Behavioral Health Disparities. With the direction of the Tribal Action Plan, the Project Coordinator will begin to work with CTCLUSI departmental staff, non-Tribal collaborative partners, and other stakeholders (including Tribal youth) to refine, enhance, and further integrate the cultural-based prevention and intervention programs and services in a manner that 1) improves accessibility to programs by all Tribal youth, 2) ensures high-risk Tribal youth receive focuses and personalized supports, 3) streamlines the flow between cultural-based programs, and 4) seamlessly coordinates service delivery. Project Goals: The goal of the Integrated Prevention and Empowerment Project is to increase the capacity of the CTCLUSI in order to reduce high risk behaviors of Tribal youth that may contribute to substance abuse, depression, and/or suicide. Measurable Objectives: To achieve the above-stated goal, the CTCLUSI will focus on fulfilling 3 objectives, including: Objective 1: Within 18 months of project launch, the CTCLUSI will adopt a Tribal Action Plan that identifies specific steps to be taken to enhance the integration of prevention and intervention programs for Tribal youth (ages 0 -24).. Objective 2: Within 3 years of project launch, the average number of Tribal youth (ages 0-24) participating in at least one CTCLUSI prevention or intervention program annually will increase by a minimum of 20 percent over the pre-project baseline. Objective 3: Within 5 years of project launch, the average number of hours a participating Tribal youth participates in a CTCLUSI prevention or intervention program annually will increase by a minimum of 40 percent over the pre-project baseline.

The Clackamas County Health System (CCHS) Zero Suicide Program is a system wide initiative to eliminate suicide attempts and deaths within its patient population and raise awareness of suicide prevention in the larger community. The project will focus on the patients aged 25 and older within CCHS, with special priority given to veterans and individuals with severe and persistent mental illness (SPMI). In year 1, the project will serve approximately 5,625 patients with improved suicide screening and treatment, and when fully implemented by year 5, will serve over 10,000 patients annually. Approximately 13,500 unduplicated patients during the project period. The CCHS Zero Suicide Program has identified goals within each of the Zero Suicide domains: • LEAD: Adoption and implementation of Zero Suicide across all CCHS clinics and service lines is leadership driven. • TRAIN: All staff are adequately trained to competently provide suicide safer care as appropriate to their role within the health system. Training in Evidence Based Practices will be implemented, including Mental Health First Aid; Counseling on Access to Lethal Means (CALM); Columbia-Suicide Severity Rating Scale (C-SSRS); Assessing and Managing Suicide Risk (AMST); Collaborative Assessment and Management of Suicidality (CAMS); and Cognitive Behavior Therapy (CBT-SP). • IDENTIFY: Patients of CCHS will be screened for suicide risk in a standardized and consistent manner. Individuals who are members of populations known to be at increased risk for suicide (i.e., veterans, individuals diagnosed with SPMI) will be identified within the health system and screened for suicide risk in a standardized and consistent manner. • ENGAGE: Patients of CCHS identified as at risk for suicide will be placed on a Suicide Safer Care pathway that includes engagement at every point of contact. • TREAT: Patients of CCHS identified as at risk for suicide will receive evidence-based suicide-specific treatment. • TRANSITION: Patients of CCHS identified as at risk for suicide will be followed and engaged through care transitions. • IMPROVE: A data-driven approach will be utilized to inform ZS implementation in CCHS to improve care for those at risk for suicide and ultimately, improve patient and patient outcomes. The CCHS Zero Suicide Program will include a rigorous evaluation and quality improvement process that will be used to shape the program implementation and advocate for improved suicide care throughout the region.

The Deschutes County Certified Community Behavioral Health Expansion Project will focus on increasing access to collaborative, integrated services for individuals with serious mental illness (SMI) or substance use disorders (SUD), including opioid disorders; children and adolescents with serious emotional disturbance (SED); and individuals with co-occurring disorders (COD) in Deschutes County, Oregon’s most rapidly-growing county. Along with the goal of increased access, the project’s other goals are: individuals served will experience improved behavioral and physical health and functioning; clients will receive person- and family-centered, trauma-informed care; all sources of available funding / support will be optimized in order to facilitate each client’s positive outcomes; and capacity of clinical competencies will be maximized in the behavioral health workforce. By July 1, 2020, the number of clients screened for any mental illness who then receive care at an integrated site will increase by 50%, up from 1,562 clients in 2017, to a total of 2,343 unduplicated clients served per year, resulting in a total of 4,686 unduplicated individuals receiving care during the two-year project term. Measurable objectives will be as follows: • By September 1, 2020, 25% additional staff will be certified to provide SUD and COD services, up from the current baseline of 28, for a total of 35 certified staff. • By September 1, 2020, there will be a 20% increase in the number of services provided to high risk clients with schizophrenia, schizoaffective, bipolar with psychotic features, and unspecified psychosis in rural communities, up from 222 services per quarter, to a total of 265 services per quarter. • By September 1, 2020, 300 individuals having received 6 months or greater of service will show an average increase of 5 in their DLA–20 score. • By September 1, 2020, 100 individuals with MDD, having received 6 months or greater of service, will show average decrease of 4 in PHQ-9 score. • By September 1, 2020, 300 unduplicated individuals with diabetes served in integrated physical/behavioral health program show 6 months or greater of control as measured by A1C less than 8. • By September 1, 2020, 300 unduplicated individuals with hypertension served in integrated physical/behavioral health program, will show 6 months or greater of hypertensive control measured by blood pressure less than 140/90 Health & Services Admin guideline (130/80 when HRSA guidelines are adjusted). • 100% of eligible services will be billed to clients’ insurance, or Medicaid / Medicare, so that CCBHC grant funding can support medically necessary services not covered by other payers.

The Deschutes County Co-Responder Program is a law enforcement and behavioral health partnership between Deschutes County Health Services and Bend Police Department. A Crisis Intervention Team (CIT) trained police officer and a behavioral health professional will work shifts together to divert adults with serious mental illness (SMI) or a co-occurring disorder (COD) from the criminal justice system prior to arrest and booking. The Co-Responder Team's approach will allow for real time, in the field, interventions focused on assessing the needs of the individual, evaluating opportunities for diversion, and connecting the individuals with community-based services. In addition to the behavioral health professional, the Co-Responder Program will include a Peer Support Specialist (PSS). The PSS will be an individual with lived life experience who will engage the individual, reduce barriers to necessary services, and provide ongoing support to ensure successful follow through and engagement. Integration into community-based services will be accomplished through coordination with DCHS programs as well as other SMI and COD community providers. Embedded within the DCHS Crisis Program, Co-Responder staff will be part of the largest community SMI and COD organization in Deschutes County. DCHS provides a wide array of evidence-based practices and services that range from traditional outpatient services to intensive community-based supports. The level of need for a co-responder program has been growing over the years. Data from the Bend PD regarding AMI (allegedly mental ill) shows ongoing increases, e.g. 2010: 664 calls compared to the 1,809 calls received in 2017 for an overall increase of 172%. The Co-Responder Program will build upon the foundation created by the CIT Program and well as the Sequential Intercept Mapping that was conducted by the Substance Abuse and Mental Health Services Administration in 2012. Project goals and objectives include: 1) increasing the number of individuals with SMI or COD who are diverted from the criminal justice system, 2) increasing the number of diverted individuals with SMI or COD who are enrolled in community-based behavioral health services, 3) increasing the number of diverted individual with SMI or COD who are enrolled in an integrated medial and behavioral health setting, 4) increasing the number of diverted veterans with SMI or COD who are receiving community-based services, and 5) increasing the number of individuals referred by law enforcement who are screened for SMI or COD. The Co-Responder Program will serve 400 individuals on an annual basis and 2,210 over a five-year period.

The Native Connection Project will build upon an array of integrated services that will reduce mental health and substance abuse disorders and ultimately prevent suicides amongst targeted youth up 24 years of age. Adverse Childhood Experiences (ACEs) scores are closely correlated with health and social disparities such as alcoholism, diabetes and unemployment.

The Native Connections Project will introduce resiliency skills to those at greatest risk and will build upon a foundation of successful suicide prevention programs and comprehensive health and mental healthcare of the Cow Creek Tribal Behavioral Health Program.

Located in Southern Oregon, the Cow Creek Band of Umpqua Tribe of Indians has experienced hundreds of years of intergenerational trauma. Trauma is a potential causative factor for long term distress, substance abuse and suicide amongst American Indian and Alaska Native communities. The Tribe's 7-county service area is one of the largest in the nation and is home to over 1,000 tribal members. Suicide rates within this service area is one of the largest in the State with an average of 20 suicides per month for all Oregonians living within the area.

The 2014 Oregon Student Wellness Survey (SWS) reported Cow Creek youth grades 6, 8 and 11 to be at an increased risk for ACEs versus other community youth with a 12.1% higher reporting of feeling sad or hopeless in the past 2 or more weeks and a 29.2% increase in actually attempting suicide.

The Native Connections Project's goals will be to reach an estimated 2,000 tribal member families and local community members within the 5-year project implementation period with the first 500 individuals being reached at the end of the Year 1 Kick-Off Event. The project will produce a cascade of trauma-informed awareness events, identification of youth and young adults primarily though the tribal clinics, resiliency skills taught at school, after school boys/girl club and tribal youth center and activities.

The Lines for Life Follow-Up project will further Lines for Life's mission to prevent suicide and substance abuse and will assist Providence Portland in their aim to successfully transition all patients with suicide attempts and/or suicide ideation to safe and ongoing care. Of the 33 states with a population of greater than 2.6 million, Oregon has the 3rd highest suicide rate. In 2015 Lines for Life, as Oregon's only affiliate to the National Suicide Prevent LifeLine, responded to 13,745 callers on the National Suicide Prevention Line. The purpose of this project is to reduce the suicide rate of individuals leaving the hospital after a suicide attempt and/or suicide ideation. This will be accomplished through a partnership in which the hospital refers patients to the LifeLine and Lines for Life follows-up with these patients. Research shows after a person presents to an Emergency Department (ED) for suicidal crisis, they are at most risk 24-48 hours after discharge from the ED. The project will increase the number of individuals screened for mental health related interventions, increase the number of individuals referred for follow-up, increase referrals to mental health related services and increase the number of individuals who come in contact with Lines for Life who go on to obtain mental health related services after receiving a referral. Lines for Life will employ the following evidence-based practices: Applied Suicide Intervention Skills Training, Motivational Interviewing, Dialectical Behavioral Therapy and the Stages of Change Model.

Peerlink National Technical Assistance Center (Peerlink NTAC), a program of Mental Health America of Oregon (MHAO), will further develop and expand our provision of technical assistance to mental health peers and peer groups, behavioral health organizations, government entities, and the general public. Peerlink NTAC's targeted technical assistance will increase peer participation in mental health system design, evaluation, and implementation; expand peer roles throughout integrated health systems; and expand the capacity and sustainability of peer-run programs and organizations. Through the effective provision of technical assistance and knowledge sharing, Peerlink NTAC will meet these Project Goals: 1. Introduce concepts of recovery and peer support in communities where these concepts are new or not generally known; specifically engaging communities that have not historically been engaged or engagement has been challenging (i.e. rural and isolated communities, veterans, youth/young adult, Native American communities); 2. Increase individual and collective voice of peers in communities across our assigned regions; 3. Increase the capacity and continued success of peer organizations by providing technical assistance specific to business and organizational development; 4. Increase the capacity of peers to provide employment supports and financial self-sufficiency courses to peers in their communities; 5. Increase the availability, quality and quantity of peer support training within the regions served; 6. Increase engagement with veteran organizations. Peerlink NTAC will reach a minimum of 3,000 persons over the first year with over 15,000 individuals impacted over the 5 year grant cycle, through a combination of choreographed strategies including: webinars, in-person training and technical assistance (TA), newsletters, websites, fact sheets, videos, radio shows, creative use of social media and new peer support services.

Mental Health America of Oregon (MHAO), a peer-run nonprofit, proposes to form the Oregon Peer Delivered Services Coalition (OPDSC). The program goals are to (1) enhance consumer participation, voice, leadership, and empowerment statewide to effect systems change and improve the quality of mental health services; (2) enhance knowledge, skills, and abilities within mental health service and/or peer support providers related to recovery and trauma-informed approaches; and (3) emphasize and build consumer leadership within the organizations and in the community, as well as through partnerships and collaboration with allied stakeholders. This project will promote activities related to the following: peer support values and standards, trauma-informed peer support, health equity, and inclusion. The proposed activities include training, leadership, and skills development; trauma-informed and gender responsive peer support and peer certification standards; diversity and cultural responsiveness; partnership development, and integrated care and wellness. Through partnership with Oregon's Coordinated Care Organizations, the Oregon Health Authority and other healthcare entities, the Coalition will aim to assume the role of the certifying body for peer specialists in the state and achieve independent sustainability.

Key interventions and strategies of the suicide prevention program are: (1) a coordinated System of Care consisting of outreach, prevention activities, clinical treatment and recovery services/supports; (2) a Statewide Youth Suicide Prevention Training Institute; (3) a full-time Outreach Specialist with ties to hospital emergency departments, Lines for Life suicide prevention helpline, and social media; (4) Project Venture evidence-based outdoor camps; (5) Oregon's Tribal Best Practices; (6) incorporation of "connectedness" in all activities; (7) alignment with Oregon's Suicide Prevention Plan and the Suicide Prevention Plan for the Northwest Portland Area Indian Health Board; and (8) partnerships with eight Oregon Tribes, higher education, Coordinated Care Organizations, hospital emergency departments, Title VII Indian Education, Native American Youth and Family Center, Northwest Portland Area Indian Health Board, and the Chemawa Indian School.
This Project is adopting the Zero Suicide approach to reduce rates of suicidal ideation, suicide attempts and suicide deaths and incorporating Goals 8 and 9 of the NSSP into its system transformation, which includes linkages with health, mental health, addictions and recovery for at-risk Native youth and their families.

NARA (Native American Rehabilitation Association of the Northwest), an integrated primary and behavioral healthcare organization, located in Portland, Oregon, will launch a system transformation initiative by implementing the Zero Suicide model. The proposed project will implement suicide prevention and intervention programs at all NARA sites that serve adults 25 years of age or older. These sites include primary health and dental care, substance abuse treatment and mental health services. The proposed project will impact the NARA health system by consistently and systematically raising awareness of suicide, establishing effective screening, assessment, and referral processes, and improving overall care and outcomes for NARA patients who are 25 years and older. and at risk for suicide. The emphasis on adults, 25 years and older is important because it bridges the gap between existing NARA youth suicide prevention services whose focus has been youth and young adults 24 years of age and younger. The bridging of this gap is crucial for the health system because it allows for a more efficient, integrated and systematized perspective for suicide prevention and intervention. For the greater Portland area community, the proposed project brings much needed access to behavioral health services, a crucial gain for a city and state that rank very low for available behavioral health resources. The project will partner with Unity Behavioral Health Center, Portland’s only Psychiatric Emergency Room and Inpatient hospital for transitional care The Zero Suicide NARA project will provide prevention and intervention services to 750 Individuals each year of the project for a total of 3,750 participants over the five years. The project proposes to train 150 staff annually. Key interventions and strategies are: (1) create a leadership hub committed to reducing suicide among those in care at NARA; (2) development of a data-driven quality improvement approach to suicide care; (3) systematically identify, assess and monitor suicidality in the entire patient population; (4) systematic monitoring along a patient’s entire treatment pathway, for purposes of triage and indication for appropriate levels of acuity and intensity of care; (5) provide responsive family and community support to those at risk, those who have attempted and those who have survived. By adopting the Zero Suicide model, NARA seeks to reduce rates of suicidal ideation, suicide attempts and suicide deaths. Through system transformation, NARA commits to goals focused on increased suicide awareness activities and education; access to prevention, treatment; data reporting capacity; increased access to quality through continuous improvement; provision of targeted, evidence-based clinical interventions; and improved accessibility, follow-up and family/caregiver engagement.