OR Discretionary Funding Fiscal Year 2021

The purpose for the Cow Creek Health & Wellness Center (CCH&WC) Mental Health & Substance Use COVID-19 Grant Project is to integrate evidenced-based mental health treatment and awareness, crisis services, and system of care wraparound strategies into the existing CCH&WC efforts. In an effort to sustain the increase in services we propose to arm our department with two new qualified staff to provide early detection, increase screenings, intensive care coordination, case management, and wrap-around recovery support services for adults and children with emotional, behavioral, and psychiatric disorders including those with Serious Mental Illness (SMI), Substance Use Disorder (SUD), and individuals with mental disorders less severe than SMI. We propose specific outreach efforts for healthcare professionals that have been impacted by COVID-19 to offer treatment and resources. We aim to increase our crisis management capacity by contracting with an after-hours crisis support line. With this project, we will observe an increased number of mental health screenings, an increased number of evaluations, a reduced number of hospitalizations due to crisis, an increased number of referrals, an increased number of multidisciplinary team cases for recovery service support, and a reduced number of calls to our after-hours crisis line. At this time, our behavioral health department is operating at maximum capacity with nearly 169 patients per week, an average of 33.8 patients per day. With the assistance of this program and the implementation of the proposed objectives, the CCH&WC could hold nearly 10,000 visits in a 16-month project period. This number does not include unscheduled crisis management appointments with our Behavioral Health Case Manager. Unmet needs for mental health and substance abuse treatment are already prevalent in our County and periods of crisis such as the one we are facing during the current COVID-19 global pandemic will increase the need for care, resources, and treatment.

NARA (Native American Rehabilitation Association of the Northwest), an Urban Indian Organization and Federally Qualified Health Care Center (FQHC), located in Portland, Oregon will continue to adapt its current strategies to provide telehealth services according to the guidelines provided by the Center for Disease Control in response to the COVID-19 virus. NARA serves primarily American Indian/Alaska Native (AI/AN) populations who have shown higher rates of substance abuse, mental health conditions, suicidality, homelessness, disabling conditions, and domestic violence when compared to other ethnicities (Lewis, Myhra, 2018). The SAMHSA 2020 COVID-19 Emergency Response for Suicide Prevention (COVID-19 ERSP) funding will reduce the impact of disparities that limit access to prevention and intervention programs, substance use and mental health services, increase screening, assessment, crisis stabilization, referral processes and prevention activities with the overall goal of continuing care during pandemic, as well as improving outcomes (e.g., C-SSRS, etc.), suicidality, and domestic violence (DV) for individuals and/or families over the period of 16 months. The primary focus is on adults, 25 years and older, who are at high risk for suicidal behaviors, as well as DV victims including their dependents who are at greater risk related to COVID-19 virus and the shelter in place order. This project will allow NARA, with the support of community partners (Cascadia’s Project Respond, The Gateway Center, and Unity Psychiatric Hospital), to continue to provide crisis intervention, prevention services, DV treatment/supports, mental and substance use disorder treatment, care coordination, case management, as well as recovery supports for 3000+ low income or underinsured individuals/families impacted by the COVID-19 pandemic. With the use of telehealth, this project brings much needed access to cultural activities, case management services, addiction and mental health services during the duration of the pandemic and beyond. Through system adaptation that aligns with the recommendations put in place by the CDC, NARA commits to goals focused on reducing barriers to care, using evidence based practices, promoting behaviors and activities that promote recovery, safety, as well, as overall well-being through the use of telehealth with the gradual integration to in person services. Key interventions and strategies are: 1. Create a leadership committee that is committed to prevention services specific to suicide and domestic violence by reducing disparities caused by limited access to direct treatment services and cultural activities during the COVID-19 pandemic; 2. Develop and implement a plan for rapid follow-up following hospitalization of suicidal patients; 3. Establish follow-up and care transition protocols to ensure patient safety among high risk suicidal adults in primary care or mental health, and substance treatment settings; 4. Provide suicide prevention training to community and clinical service providers; 5. Collaborate with community organizations and systems to implement comprehensive suicide prevention (e.g., Cascadia’s Project Respond, The Gateway Center, Unity Hospital, etc.); 6. Provide suicide screening, assessment and appropriate clinical treatment services based on assessment; 7. Provide community recovery supports to assist individuals and their family members who attempted or are at risk for attempting suicide; 8. Develop protocol for enhanced screening of individuals at risk for domestic violence; 9. Provide enhanced services for victims and dependents of domestic violence based upon screening and assessment treatment services; 10. Provide patient supports that promote safety and well-being of domestic violence victims and those at risk for suicide.

Oregon Emergency COVID-19 Grant

The Adapt CCBHC Project will increase integration of current behavioral health and primary care services in Douglas County and expand these services to better serve the target populations. Activities for the funding include moving from three EHRs to one for the entire agency, developing a single intake process, providing open rather than scheduled access to care, and addressing workforce issues that contribute to staff and consumer turnover. Target populations include consumers with serious mental illness, a severe substance use disorder, and youth with severe emotional disturbance. Other populations who will benefit are those experiencing disenfranchisement, such as minorities, homeless, and former military service members, especially those who are ineligible for or otherwise disenchanted with VA services. Because these populations can be high-needs members of the community, impacts on quality of care will directly benefit other community systems, such as hospital emergency department, jail, and law enforcement. Objectives of the program include: 1) Implementation of a single EHR to replace three EHRs currently in use. This will allow the coordination of care between providers of the medical and behavioral health services currently offered in the agency. 2) Reaching consumers when and where they are ready for services by decreasing the time between initial contact and service delivery from days to hours. Current time between first contact and assessment is about 2 weeks for standard behavioral health services. Tests of open access have indicated that this time can be reduced to the same day by adjusting the process for intake and a 5% increase in staffing. Implementing this across all behavioral health services would provide an increase in access to services. 3) Serving an additional 490 consumers each year of the grant, a 20% increase over the 2,450 already served. 4) Reducing staff turnover by 30%. This is achieved by decreasing caseloads, the main factor that contributes to burnout and staff turnover. Turnover makes it difficult to expand services since we recruit to fill vacant positions rather than expanded positions. A salary analysis to determine if there are positions that are not paid in line with other providers in the region. 5) Keeping consumers engaged in care, as measured by the 90-day and 180-day retention measures, which are expected to increase by 10% over the two-year project. The project will minimize intake processes and the time between when services are sought by consumers and when they are received. Our goal is to have services when and where a consumer needs them, that they do not experience a wrong door or dead end, and we have staff who are able to do the fulfilling work they trained to do.

BestCare Jefferson CCBHC Project Abstract We meet complex client needs providing a full continuum of services across our organization ranging from outpatient, to intensive outpatient, to substance use disorder residential treatment, to brief mental health crisis stabilization and intervention in a respite setting, detoxification/ withdrawal management, and medication assisted treatment for opioid use disorders. Our Jefferson County CMHP has developed unique programming to fill gaps such as our Brooks Crisis Respite facility, in response to an identified regional gap in brief crisis respite treatment, and placement of behavioral health staff in the St. Charles Medical Center Emergency Department in the Madras Hospital, and have plans to develop a mental health treatment home. We address complex needs of individuals from cradle to grave, through the provision of 24/7 Mobile Crisis, Assertive Community Treatment, (ACT) and more recently are developing Intensive In-Home Behavioral Health Treatment. (IIBHT), and seek to strengthen the framework of services we have been able to develop by attaining CCBHC status. Our catchment area includes the Confederated Tribes of Warm Springs, rural agricultural and ranching communities, more geographically isolated frontier areas, and individuals from many different Spanish-speaking ethnicities, who traditionally have cultural barriers to admitting to the need for behavioral health services. People from Native American and Latino cultures are numerous and underserved in the areas where we operate, especially tribal members that are Veterans. Socioeconomically, many experience extreme poverty, especially those from the most rural and frontier areas. There is a high rate of opioid dependence, overdose and death, severe medical conditions co-occurring with mental health and substance use disorders. Homelessness and housing insecurity are prevalent across the area, especially for those with severe substance use disorder and severe and persistent mental illness. We strive to provide personalized, client and family centered planning and culturally responsive, trauma sensitive treatment to all we serve, integrating peer support provided by those with lived experience to bring hope and model recovery. Obtaining CCBHC funding will allow us to expand our most intensive services, provide rapid access to mental health counseling and psychiatric care, bring on nursing staff to conduct screenings, and address findings by coordinating care with our local FQHC, and conduct more robust outreach to tribal members and Veterans that are underserved.

Implementation of Zero Suicide in Clackamas County Health System